Provider Demographics
NPI:1457403362
Name:OKEEFE, ELIZABETH BAYLEY MCMAHON (LICSW)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:BAYLEY MCMAHON
Last Name:OKEEFE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:OKEEFE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5 ADAMS LANE
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:NH
Mailing Address - Zip Code:03608
Mailing Address - Country:US
Mailing Address - Phone:603-313-4011
Mailing Address - Fax:
Practice Address - Street 1:58 ADAMS LANE
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:NH
Practice Address - Zip Code:03608
Practice Address - Country:US
Practice Address - Phone:603-313-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30424055Medicaid
74479OtherPBH UBH
NH11553094OtherCAQH
NH042781OtherVALUE OPTIONS
NH1053490OtherCIGNA
NH14YM9979NH01OtherBCBS ANTHEM BHN
6296196OtherUBH PACIFIC HEALTH CARE
NH7839503OtherAETNA