Provider Demographics
NPI:1073751202
Name:FINEBERG, ELIZABETH (LICSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:FINEBERG
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5232
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-6232
Mailing Address - Country:US
Mailing Address - Phone:508-655-6322
Mailing Address - Fax:508-655-9793
Practice Address - Street 1:35 MAIN ST
Practice Address - Street 2:#3
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-5037
Practice Address - Country:US
Practice Address - Phone:508-655-6322
Practice Address - Fax:508-655-9793
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA104657-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAFI PO3531OtherBLUE CROSS BLUE SHIELD
MAFI PO3531OtherBLUE CROSS BLUE SHIELD