Healthcare Provider Details

I. General information

NPI: 1477021632
Provider Name (Legal Business Name): MISS ELYSE TAYLOR MCCUE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2018
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 UNION ST
LYNN MA
01901-1311
US

IV. Provider business mailing address

96 FRANKLIN AVE
SWAMPSCOTT MA
01907-1145
US

V. Phone/Fax

Practice location:
  • Phone: 781-244-1950
  • Fax:
Mailing address:
  • Phone: 781-603-3322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW127512
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: