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General NPI Number Information
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NPI Number | 1073659645
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Entity Type | Individual
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Provider Name | ELIZABETH MACIOLEK LICSW
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Gender | Female
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 02/10/2009
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Provider Practice Location Address
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Address Line | 5 BANFILL LN
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City | SOUTHBOROUGH
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State | MA
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Zip | 01772-1719
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Country | US
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Telephone | 508-485-2393
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Fax |
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Provider Business Mailing Address
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Address Line | 42 POWERS DR
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City | CENTERVILLE
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State | MA
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Zip | 02632-3341
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Country | US
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Telephone | 508-428-5167
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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 | 1018316
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License Number State | MA
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