Healthcare Provider Details

I. General information

NPI: 1700216546
Provider Name (Legal Business Name): ELIZABETH LEVASSEUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2013
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 CENTRAL AVE
NEEDHAM MA
02492-1410
US

IV. Provider business mailing address

3 STONE END RD
MEDWAY MA
02053-2247
US

V. Phone/Fax

Practice location:
  • Phone: 781-292-2171
  • Fax: 781-453-0808
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number118555
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: