Healthcare Provider Details

I. General information

NPI: 1114792629
Provider Name (Legal Business Name): ELIZAVETA MITROFANOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ARCH PL
GREENFIELD MA
01301-2457
US

IV. Provider business mailing address

1 ARCH PL
GREENFIELD MA
01301-2457
US

V. Phone/Fax

Practice location:
  • Phone: 413-774-1000
  • Fax: 413-774-1776
Mailing address:
  • Phone: 413-774-1000
  • Fax: 413-774-1776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW1143398
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089.0137072
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: