Provider Demographics
NPI:1144867599
Name:STOCKWELL, ELIZABETH JANE (LCSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JANE
Last Name:STOCKWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 ANDERSEN DR
Mailing Address - Street 2:
Mailing Address - City:BOXFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01921-1409
Mailing Address - Country:US
Mailing Address - Phone:617-806-6345
Mailing Address - Fax:
Practice Address - Street 1:242 KINGSLAND AVE APT 1R
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-4325
Practice Address - Country:US
Practice Address - Phone:617-806-6345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-04
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105383104100000X
NY0944461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker