Provider Demographics
NPI:1831307164
Name:HARDY, ELIZABETH ANNE (LICSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNE
Last Name:HARDY
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 1:99 WALNUT ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-1980
Mailing Address - Country:US
Mailing Address - Phone:617-784-9045
Mailing Address - Fax:
Practice Address - Street 1:99 WALNUT ST
Practice Address - Street 2:SUITE F
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-1980
Practice Address - Country:US
Practice Address - Phone:617-784-9045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1122581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical