Healthcare Provider Details

I. General information

NPI: 1396041158
Provider Name (Legal Business Name): ELISSA BARGAS LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2011
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 CHESTNUT ST STE 230
WORCESTER MA
01608-1557
US

IV. Provider business mailing address

18 CHESTNUT ST STE 230
WORCESTER MA
01608-1557
US

V. Phone/Fax

Practice location:
  • Phone: 774-417-1756
  • Fax: 508-365-6103
Mailing address:
  • Phone: 774-417-1756
  • Fax: 508-365-6103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number119044
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: