Provider Demographics
NPI:1114972452
Name:ELLIOTT, RICHARD W (LICSW)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:W
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4339
Mailing Address - Country:US
Mailing Address - Phone:617-774-0920
Mailing Address - Fax:617-774-0925
Practice Address - Street 1:1250 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4339
Practice Address - Country:US
Practice Address - Phone:617-774-0920
Practice Address - Fax:617-774-0925
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1065571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO4142OtherBLUE CROSS
MA669497OtherTUFTS HEALTH PLAN
MA669497OtherTUFTS HEALTH PLAN