Basic Information
| Provider Information | |||||||||
| NPI: | 1891445748 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ELAINE FILLION-CROUSE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 388 BEDFORD ST | ||||||||
| Address2: | |||||||||
| City: | LAKEVILLE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023472110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088132847 | ||||||||
| FaxNumber: | 5084331871 | ||||||||
| Practice Location | |||||||||
| Address1: | 992 BEDFORD ST | ||||||||
| Address2: | |||||||||
| City: | BRIDGEWATER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023243050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088132847 | ||||||||
| FaxNumber: | 5084331871 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2022 | ||||||||
| LastUpdateDate: | 03/24/2022 | ||||||||
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| AuthorizedOfficialLastName: | FILLION-CROUSE | ||||||||
| AuthorizedOfficialFirstName: | ELAINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5088132847 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LICSW | ||||||||
| NPICertificationDate: | 03/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.