Provider Demographics
NPI:1952741225
Name:GRSKOVIC, ELLENA (LICSW)
Entity Type:Individual
Prefix:
First Name:ELLENA
Middle Name:
Last Name:GRSKOVIC
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ELLENA
Other - Middle Name:
Other - Last Name:MCFARLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:36 APPLETON ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-6245
Mailing Address - Country:US
Mailing Address - Phone:201-400-0320
Mailing Address - Fax:
Practice Address - Street 1:399 BOYLSTON ST STE 900
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3305
Practice Address - Country:US
Practice Address - Phone:857-285-3816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA120980101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health