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General NPI Number Information
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NPI Number | 1033479068
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Entity Type | Individual
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Provider Name | ELIZABETH ANN PUTELIS
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Gender | Female
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Dates
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Enumeration Date | 05/24/2012
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Last Update Date | 04/03/2018
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Provider Practice Location Address
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Address Line | 330 SW CUTOFF STE 203
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City | WORCESTER
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State | MA
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Zip | 01604-2730
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Country | US
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Telephone | 508-341-2829
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Fax |
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Provider Business Mailing Address
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Address Line | 105 WALLACE AVE
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City | AUBURN
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State | MA
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Zip | 01501-1103
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Country | US
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Telephone | 508-981-1930
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 2047
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License Number State | MA
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