Provider Demographics
NPI:1417963521
Name:MARCOTTE, ELIZABETH ANN (MSW, LCSW, LICSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:MARCOTTE
Suffix:
Gender:F
Credentials:MSW, LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 DOW HIGHWAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ELIOT
Mailing Address - State:ME
Mailing Address - Zip Code:03903-1428
Mailing Address - Country:US
Mailing Address - Phone:207-451-9151
Mailing Address - Fax:207-438-0202
Practice Address - Street 1:178 DOW HIGHWAY
Practice Address - Street 2:SUITE 1
Practice Address - City:ELIOT
Practice Address - State:ME
Practice Address - Zip Code:03903-1428
Practice Address - Country:US
Practice Address - Phone:207-451-9151
Practice Address - Fax:207-438-0202
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC69801041C0700X
NH10341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEA997416OtherVALUE OPTIONS
NH114097OtherTEAMSTERS BEHAVIORAL HEAL
NH30422515Medicaid
ME060594OtherANTHEM BCBS
NH14Y001556NH01OtherANTHEM NH INDEMNITY
ME251266OtherCOMPSYCH