Provider Demographics
NPI:1225199920
Name:HATOW, ELAINE ELIZABETH (LICSW, BCD)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:ELIZABETH
Last Name:HATOW
Suffix:
Gender:F
Credentials:LICSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1319
Mailing Address - Country:US
Mailing Address - Phone:617-558-2724
Mailing Address - Fax:617-558-2724
Practice Address - Street 1:23 PLEASANT ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-1836
Practice Address - Country:US
Practice Address - Phone:617-558-2724
Practice Address - Fax:617-558-2724
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA104484 LICSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA701874OtherTUFTS ASSOCIATED HEALTH P
MAP21477Medicare ID - Type Unspecified