MEDICARE: MS. CHRISTINA MCELROY LICSW

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	113755	MA

General Provider Information

NPI Number	:	1558430447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHRISTINA MCELROY LICSW

Provider Business Mailing Address
First Line	:	5222 AVALON DRIVE
Second Line	:
City	:	WEYMOUTH
State	:	MA
Zip	:	02188
Country	:	US
Telephone Number	:	781-812-0238
Fax Number	:	781-987-7227

Provider Business Practice Location Address
First Line	:	185 MAIN ST
Second Line	:	SUITE 28
City	:	AVON
State	:	MA
Zip	:	02322-1452
Country	:	US
Telephone Number	:	781-929-2356
Fax Number	:	178-198-7722

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	10/21/2007

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