Provider Demographics
NPI:1710390992
Name:SURPRENANT, ELIZABETH (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:SURPRENANT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:D'ONOFRIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:187 MOUNT VERNON STREET
Mailing Address - Street 2:APT. 2E
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843
Mailing Address - Country:US
Mailing Address - Phone:978-225-3249
Mailing Address - Fax:844-432-5011
Practice Address - Street 1:187 MOUNT VERNON STREET
Practice Address - Street 2:APT. 2E
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843
Practice Address - Country:US
Practice Address - Phone:978-225-3249
Practice Address - Fax:844-432-5011
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-05
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NH25761041C0700X
MA1202351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health