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General NPI Number Information
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NPI Number | 1003225657
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Entity Type | Individual
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Provider Name | MARY BETH ELLIOTT LICSW
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Gender | Female
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Dates
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Enumeration Date | 08/07/2014
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Last Update Date | 08/08/2025
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Provider Practice Location Address
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Address Line | BOSTON NEURODYNAMICS 521 MT. AUBURN ST. SUITE #205
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City | WATERTOWN
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State | MA
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Zip | 02472
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Country | US
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Telephone | 614-855-9295
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Fax |
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Provider Business Mailing Address
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Address Line | BOSTON NEURODYNAMICS 521 MT. AUBURN ST. SUITE #205
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City | WATERTOWN
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State | MA
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Zip | 02472
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Country | US
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Telephone | 614-855-9295
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 117540
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW000005933
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LICSW117540
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License Number State | MA
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