Basic Information
| Provider Information | |||||||||
| NPI: | 1407101181 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SARANTOPOULOS | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 OCEAN AVENUE | ||||||||
| Address2: | MGH REVERE | ||||||||
| City: | REVERE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814856264 | ||||||||
| FaxNumber: | 7814856391 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 OCEAN AVE | ||||||||
| Address2: | |||||||||
| City: | REVERE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021513675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814856264 | ||||||||
| FaxNumber: | 7814856391 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2012 | ||||||||
| LastUpdateDate: | 07/18/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 116728 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.