Provider Demographics
NPI:1619545233
Name:ELISABETH SECOR, LICSW LLC
Entity Type:Organization
Organization Name:ELISABETH SECOR, LICSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELISABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SECOR
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:781-462-6030
Mailing Address - Street 1:226 LOWELL ST STE B7
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-3073
Mailing Address - Country:US
Mailing Address - Phone:781-462-6030
Mailing Address - Fax:
Practice Address - Street 1:226 LOWELL ST STE B7
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01887-3073
Practice Address - Country:US
Practice Address - Phone:781-462-6030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303414Medicaid