MEDICARE: ELIZABETH ANNE BOOTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SC00853200	NJ

General Provider Information

NPI Number	:	1063847945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELIZABETH ANNE BOOTH LLC

Provider Business Mailing Address
First Line	:	38 HAWTHORNE AVE
Second Line	:
City	:	MORRIS PLAINS
State	:	NJ
Zip	:	07950-1709
Country	:	US
Telephone Number	:	973-476-3520
Fax Number	:

Provider Business Practice Location Address
First Line	:	38 HAWTHORNE AVE
Second Line	:
City	:	MORRIS PLAINS
State	:	NJ
Zip	:	07950-1709
Country	:	US
Telephone Number	:	973-476-3520
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL SOCIAL WORKER
Name	:	ELIZABETH ANNE BOOTH
Credential	:	LCSW
Telephone Number	:	973-476-3520

Provider Enumeration Date	:	09/10/2013
Last Update Date	:	11/12/2024

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