Provider Demographics
NPI:1811045537
Name:WAINGROW, ELISABETH ELLIS (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:ELISABETH
Middle Name:ELLIS
Last Name:WAINGROW
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 610094
Mailing Address - Street 2:
Mailing Address - City:NEWTON HIGHLANDS
Mailing Address - State:MA
Mailing Address - Zip Code:02461-0094
Mailing Address - Country:US
Mailing Address - Phone:617-244-8132
Mailing Address - Fax:
Practice Address - Street 1:24 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:NEWTON HIGHLANDS
Practice Address - State:MA
Practice Address - Zip Code:02461-1524
Practice Address - Country:US
Practice Address - Phone:617-244-8132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA104093101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP01953OtherBCBS