Healthcare Provider Details

I. General information

NPI: 1376833467
Provider Name (Legal Business Name): ELIZABETH HYLTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 09/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 FRONT ST 5TH FLOOR
WORCESTER MA
01608-1732
US

IV. Provider business mailing address

255 PARK AVE STE 804
WORCESTER MA
01609-1984
US

V. Phone/Fax

Practice location:
  • Phone: 508-756-5400
  • Fax:
Mailing address:
  • Phone: 508-756-5400
  • Fax: 508-756-5433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN2259657
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: