Healthcare Provider Details

I. General information

NPI: 1568532257
Provider Name (Legal Business Name): ELIZABETH ANNE SUNSHINE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: E ANNE SUNSHINE LICSW

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 04/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 ELDREDGE ST
NEWTON MA
02458-2017
US

IV. Provider business mailing address

BOSTON BEHAVIORAL MEDICINE 1371 BEACON ST., SUITE 304
BROOKLINE MA
20446-4905
US

V. Phone/Fax

Practice location:
  • Phone: 617-969-4925
  • Fax: 617-969-2507
Mailing address:
  • Phone: 617-777-3153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number113712
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: