Provider Demographics
NPI:1114192788
Name:WHITTAKER, ELIZABETH ROSE (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ROSE
Last Name:WHITTAKER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SLEEPY HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-3579
Mailing Address - Country:US
Mailing Address - Phone:508-591-0593
Mailing Address - Fax:
Practice Address - Street 1:103 COURT ST STE C
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-8713
Practice Address - Country:US
Practice Address - Phone:508-591-0593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11547-MH-CC101YM0800X
MA425510101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool