Provider Demographics
NPI:1245463736
Name:ST. BRICE, ELIE SR (MSW)
Entity type:Individual
Prefix:MR
First Name:ELIE
Middle Name:
Last Name:ST. BRICE
Suffix:SR
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-1833
Mailing Address - Country:US
Mailing Address - Phone:617-442-7400
Mailing Address - Fax:617-541-3797
Practice Address - Street 1:435 WARREN ST
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-1833
Practice Address - Country:US
Practice Address - Phone:617-442-7400
Practice Address - Fax:617-541-3797
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor