Provider Demographics
NPI:1013400100
Name:SPARKS, ELIZABETH ELAINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ELAINE
Last Name:SPARKS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-3800
Mailing Address - Country:US
Mailing Address - Phone:617-552-0698
Mailing Address - Fax:617-552-0398
Practice Address - Street 1:140 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-3800
Practice Address - Country:US
Practice Address - Phone:617-552-0698
Practice Address - Fax:617-552-0398
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5025103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist