Healthcare Provider Details

I. General information

NPI: 1225199920
Provider Name (Legal Business Name): ELAINE ELIZABETH HATOW LICSW, BCD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 PLEASANT ST SUITE 2
NEWTON MA
02459-1836
US

IV. Provider business mailing address

646 GROVE ST
NEWTON MA
02462-1319
US

V. Phone/Fax

Practice location:
  • Phone: 617-558-2724
  • Fax: 617-558-2724
Mailing address:
  • Phone: 617-558-2724
  • Fax: 617-558-2724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number104484 LICSW
License Number StateMA

VII. Legacy identifiers

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

# 1
Identifier701874
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerTUFTS ASSOCIATED HEALTH P

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: