Provider Demographics
NPI:1295483261
Name:ELIZABETH RAGUSA LICSW LLC
Entity type:Organization
Organization Name:ELIZABETH RAGUSA LICSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:LAURA
Authorized Official - Last Name:RAGUSA
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:207-576-4574
Mailing Address - Street 1:3 KLIFFORD CIR
Mailing Address - Street 2:
Mailing Address - City:MILLIS
Mailing Address - State:MA
Mailing Address - Zip Code:02054-1327
Mailing Address - Country:US
Mailing Address - Phone:207-576-4574
Mailing Address - Fax:
Practice Address - Street 1:3 KLIFFORD CIR
Practice Address - Street 2:
Practice Address - City:MILLIS
Practice Address - State:MA
Practice Address - Zip Code:02054-1327
Practice Address - Country:US
Practice Address - Phone:207-576-4574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty