Provider Demographics
NPI:1902039001
Name:STRODE, ELIZA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:ELIZA
Middle Name:
Last Name:STRODE
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 1:36 BEECHER ST
Mailing Address - Street 2:#2
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4910
Mailing Address - Country:US
Mailing Address - Phone:617-308-7026
Mailing Address - Fax:
Practice Address - Street 1:36 BEECHER ST
Practice Address - Street 2:#2
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-4910
Practice Address - Country:US
Practice Address - Phone:617-308-7026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1104041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical