Provider Demographics
NPI:1548729403
Name:STURGEON, ELIZABETH (LICSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:STURGEON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 FRONT ST APT 440
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-4852
Mailing Address - Country:US
Mailing Address - Phone:401-932-9543
Mailing Address - Fax:
Practice Address - Street 1:456 PROVIDENCE HWY
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-6815
Practice Address - Country:US
Practice Address - Phone:781-915-8424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2233531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical