Provider Demographics
NPI:1558005256
Name:DAVIS, ELIZABETH OWENS ((MA) LICSW (ME)LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:OWENS
Last Name:DAVIS
Suffix:
Gender:F
Credentials:(MA) LICSW (ME)LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-0157
Mailing Address - Country:US
Mailing Address - Phone:508-930-5753
Mailing Address - Fax:
Practice Address - Street 1:144 NORTH RD
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-1156
Practice Address - Country:US
Practice Address - Phone:978-287-0810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC140361041C0700X
MA1055831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical