Healthcare Provider Details

I. General information

NPI: 1417963521
Provider Name (Legal Business Name): ELIZABETH ANN MARCOTTE MSW, LCSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 DOW HIGHWAY SUITE 1
ELIOT ME
03903-1428
US

IV. Provider business mailing address

178 DOW HIGHWAY SUITE 1
ELIOT ME
03903-1428
US

V. Phone/Fax

Practice location:
  • Phone: 207-451-9151
  • Fax: 207-438-0202
Mailing address:
  • Phone: 207-451-9151
  • Fax: 207-438-0202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC6980
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1034
License Number StateNH

VII. Legacy identifiers

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

# 1
IdentifierA997416
Identifier TypeOTHER
Identifier StateME
Identifier IssuerVALUE OPTIONS
# 2
Identifier114097
Identifier TypeOTHER
Identifier StateNH
Identifier IssuerTEAMSTERS BEHAVIORAL HEAL
# 3
Identifier30422515
Identifier TypeMEDICAID
Identifier StateNH
Identifier Issuer
# 4
Identifier060594
Identifier TypeOTHER
Identifier StateME
Identifier IssuerANTHEM BCBS
# 5
Identifier14Y001556NH01
Identifier TypeOTHER
Identifier StateNH
Identifier IssuerANTHEM NH INDEMNITY
# 6
Identifier251266
Identifier TypeOTHER
Identifier StateME
Identifier IssuerCOMPSYCH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: