Provider Demographics
NPI:1891714523
Name:DOUGLAS, ELIZABETH (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:DOUGLAS
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 1:8 RIPPOWAM RD
Mailing Address - Street 2:
Mailing Address - City:COS COB
Mailing Address - State:CT
Mailing Address - Zip Code:06807-2139
Mailing Address - Country:US
Mailing Address - Phone:203-302-1050
Mailing Address - Fax:
Practice Address - Street 1:1170 BEACON ST
Practice Address - Street 2:REAR GARDEN SUITE
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3963
Practice Address - Country:US
Practice Address - Phone:617-566-3866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2018-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2120791041C0700X
MA1134181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical