Provider Demographics
NPI:1134639768
Name:TOUSIGNANT, ELAINE DONNA (LICSW)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:DONNA
Last Name:TOUSIGNANT
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 1:40 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-3361
Mailing Address - Country:US
Mailing Address - Phone:978-840-9301
Mailing Address - Fax:
Practice Address - Street 1:40 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-3361
Practice Address - Country:US
Practice Address - Phone:978-840-9301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2215511041C0700X
MA122004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical