Provider Demographics
NPI:1487831053
Name:DANFORTH, ELIZABETH A (LICSW)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:A
Last Name:DANFORTH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:DANFORTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:27 W MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-1331
Mailing Address - Country:US
Mailing Address - Phone:508-340-1206
Mailing Address - Fax:
Practice Address - Street 1:14 BALLARD ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MA
Practice Address - Zip Code:01540-1602
Practice Address - Country:US
Practice Address - Phone:508-340-1206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-26
Last Update Date:2008-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10250271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical