Provider Demographics
NPI:1912494964
Name:CIAK, ELIZABETH J (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:CIAK
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:J
Other - Last Name:LUCAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 MYRON ST STE A
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-1485
Mailing Address - Country:US
Mailing Address - Phone:413-592-1980
Mailing Address - Fax:413-439-0100
Practice Address - Street 1:103 MYRON ST STE A
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-1485
Practice Address - Country:US
Practice Address - Phone:413-592-1980
Practice Address - Fax:413-439-0100
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1200721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical