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NPI Code Detail

MEDICARE: ELISABETH SECOR, LICSW LLC

MEDICARE: ELISABETH SECOR, LICSW 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
1101YM0800XMental Health Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619545233
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELISABETH SECOR, LICSW LLC
Provider Business Mailing Address
First Line : 226 LOWELL ST STE B7
Second Line :
City : WILMINGTON
State : MA
Zip : 01887-3073
Country : US
Telephone Number : 781-462-6030
Fax Number :
Provider Business Practice Location Address
First Line : 226 LOWELL ST STE B7
Second Line :
City : WILMINGTON
State : MA
Zip : 01887-3073
Country : US
Telephone Number : 781-462-6030
Fax Number :
Authorized Official
Title or Position : OWNER
Name : ELISABETH SECOR
Credential : LICSW
Telephone Number : 781-462-6030
Provider Enumeration Date : 06/11/2021
Last Update Date : 06/11/2021

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Directions to “ELISABETH SECOR, LICSW LLC ” Practice Location

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