Provider Demographics
NPI:1275762585
Name:BOUSA, ELIZABETH ASHLEY
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ASHLEY
Last Name:BOUSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ASHLEY
Other - Last Name:STOCKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:132 ESSEX ST
Mailing Address - Street 2:APT. 305
Mailing Address - City:SOUTH HAMILTON
Mailing Address - State:MA
Mailing Address - Zip Code:01982-2315
Mailing Address - Country:US
Mailing Address - Phone:540-270-2799
Mailing Address - Fax:
Practice Address - Street 1:9 CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-7906
Practice Address - Country:US
Practice Address - Phone:978-927-9410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health