Provider Demographics
NPI:1518168194
Name:FOUNTAIN, ELIZABETH ALISON
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:ALISON
Last Name:FOUNTAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 SUMMER ST
Mailing Address - Street 2:SUITE 202A
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-3469
Mailing Address - Country:US
Mailing Address - Phone:617-872-4859
Mailing Address - Fax:508-884-2476
Practice Address - Street 1:35 SUMMER ST
Practice Address - Street 2:SUITE 202A
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3469
Practice Address - Country:US
Practice Address - Phone:617-872-4859
Practice Address - Fax:508-884-2746
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator