Provider Demographics
NPI:1710087796
Name:ELLIOTT, GERALDINE ANN (LICSW)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:ANN
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 LIBERTY STREET
Mailing Address - Street 2:SUITE 212
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923
Mailing Address - Country:US
Mailing Address - Phone:978-762-5435
Mailing Address - Fax:
Practice Address - Street 1:10 LIBERTY STREET
Practice Address - Street 2:SUITE 212
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923
Practice Address - Country:US
Practice Address - Phone:978-762-5435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10290531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAELP07352OtherBCBS MEDEX
543231000OtherMAGELLAN BEHAVIORAL HEALT
ELP20631Medicare ID - Type Unspecified