Provider Demographics
NPI:1386864189
Name:PADDOCK, ELIZABETH H (LICSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:H
Last Name:PADDOCK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 MOUNT PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-4329
Mailing Address - Country:US
Mailing Address - Phone:617-314-4570
Mailing Address - Fax:978-282-8223
Practice Address - Street 1:65 MOUNT PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-4329
Practice Address - Country:US
Practice Address - Phone:978-282-8225
Practice Address - Fax:978-282-8223
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1148001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical