Healthcare Provider Details

I. General information

NPI: 1598539868
Provider Name (Legal Business Name): ELIZABETH SIROIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 BUCKSPORT RD
ELLSWORTH ME
04605-2733
US

IV. Provider business mailing address

PO BOX 1769
ELLSWORTH ME
04605-5269
US

V. Phone/Fax

Practice location:
  • Phone: 207-212-8993
  • Fax:
Mailing address:
  • Phone: 207-212-8993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC25437
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: