MEDICARE: ELIZABETH JANE STOCKWELL LCSW

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	104100000X	Social Worker	105383	NY
2	1041C0700X	Clinical Social Worker	094446	NY

General Provider Information

NPI Number	:	1144867599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH JANE STOCKWELL LCSW

Provider Business Mailing Address
First Line	:	42 ANDERSEN DR
Second Line	:
City	:	BOXFORD
State	:	MA
Zip	:	01921-1409
Country	:	US
Telephone Number	:	617-806-6345
Fax Number	:

Provider Business Practice Location Address
First Line	:	242 KINGSLAND AVE APT 1R
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11222-4325
Country	:	US
Telephone Number	:	617-806-6345
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2019
Last Update Date	:	12/05/2022

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