Provider Demographics
NPI:1134604929
Name:ELLEN, ELIZABETH FRIED (LICSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:FRIED
Last Name:ELLEN
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 1:115 PAGE RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1817
Mailing Address - Country:US
Mailing Address - Phone:781-883-4511
Mailing Address - Fax:781-271-9329
Practice Address - Street 1:115 PAGE RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-1817
Practice Address - Country:US
Practice Address - Phone:781-883-4511
Practice Address - Fax:781-271-9329
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10248501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical