Provider Demographics
NPI:1255466074
Name:CROTEAU POLAK, ELIZABETH JA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:JA
Last Name:CROTEAU POLAK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:JA
Other - Last Name:CROTEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:242 WOODLAND ST
Practice Address - Street 2:
Practice Address - City:WEST BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01583-1670
Practice Address - Country:US
Practice Address - Phone:508-853-6221
Practice Address - Fax:508-835-4859
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1146691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical