Healthcare Provider Details

I. General information

NPI: 1164569042
Provider Name (Legal Business Name): ELIZABETH ANN BOSWORTH LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH ANN TATRO LICSW

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 10/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 HILLSIDE ST DEPARTMENT OF MENTAL HEALTH
FALL RIVER MA
02720-5211
US

IV. Provider business mailing address

47 SEYMOUR AVE
SOMERSET MA
02726-5308
US

V. Phone/Fax

Practice location:
  • Phone: 508-235-7209
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW01057
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number114590
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: