Provider Demographics
NPI:1285863548
Name:ROKOS, ELYSE (LICSW)
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:
Last Name:ROKOS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ELYSE
Other - Middle Name:
Other - Last Name:SEARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:77 ARDALE ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02131-1402
Mailing Address - Country:US
Mailing Address - Phone:860-480-0127
Mailing Address - Fax:
Practice Address - Street 1:705 MOUNT AUBURN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-1508
Practice Address - Country:US
Practice Address - Phone:617-335-0307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA117028104100000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator