Provider Demographics
NPI:1710450481
Name:BRACH, ELIZABETH LAURA (LICSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LAURA
Last Name:BRACH
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 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-5811
Mailing Address - Country:US
Mailing Address - Phone:781-863-8165
Mailing Address - Fax:
Practice Address - Street 1:10 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-5811
Practice Address - Country:US
Practice Address - Phone:781-863-8165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-05
Last Update Date:2019-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA105001104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker