Provider Demographics
NPI:1285868430
Name:STALEY, ELIZABETH ANNE (LCSW, LICSW, LPC)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANNE
Last Name:STALEY
Suffix:
Gender:F
Credentials:LCSW, LICSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 MAIN ST APT A
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01267-2647
Mailing Address - Country:US
Mailing Address - Phone:413-458-4823
Mailing Address - Fax:413-458-4823
Practice Address - Street 1:515 MAIN ST APT A
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:MA
Practice Address - Zip Code:01267-2647
Practice Address - Country:US
Practice Address - Phone:413-458-4823
Practice Address - Fax:413-458-4823
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-02
Last Update Date:2009-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4490101Y00000X
TX05169104100000X, 1041C0700X
MA1141081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker