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General NPI Number Information
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NPI Number | 1144867599
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Entity Type | Individual
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Provider Name | ELIZABETH JANE STOCKWELL LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/04/2019
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Last Update Date | 12/05/2022
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Provider Practice Location Address
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Address Line | 242 KINGSLAND AVE APT 1R
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City | BROOKLYN
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State | NY
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Zip | 11222-4325
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Country | US
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Telephone | 617-806-6345
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Fax |
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Provider Business Mailing Address
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Address Line | 42 ANDERSEN DR
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City | BOXFORD
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State | MA
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Zip | 01921-1409
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Country | US
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Telephone | 617-806-6345
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 105383
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License Number State | NY
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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 | 094446
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License Number State | NY
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