Provider Demographics
NPI:1578551156
Name:ROBERT, ELISABETH M (LICSW, BCD, CHT)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:M
Last Name:ROBERT
Suffix:
Gender:F
Credentials:LICSW, BCD, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 SPRING ST
Mailing Address - Street 2:SUITE 309
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-5951
Mailing Address - Country:US
Mailing Address - Phone:508-999-1960
Mailing Address - Fax:508-999-1204
Practice Address - Street 1:106 SPRING ST
Practice Address - Street 2:SUITE 309
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-5951
Practice Address - Country:US
Practice Address - Phone:508-999-1960
Practice Address - Fax:508-999-1204
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-08
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10234611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP21241Medicare PIN