Provider Demographics
NPI:1669764510
Name:CLEARY, ELISA ELKIN (LICSW)
Entity type:Individual
Prefix:MS
First Name:ELISA
Middle Name:ELKIN
Last Name:CLEARY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ELISA
Other - Middle Name:
Other - Last Name:ELKIN-CLEARY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:8 WESTWAY RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-2807
Mailing Address - Country:US
Mailing Address - Phone:774-421-9282
Mailing Address - Fax:
Practice Address - Street 1:9 MERIAM ST
Practice Address - Street 2:UNIT 18
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-5300
Practice Address - Country:US
Practice Address - Phone:774-421-9282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1143261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical