Provider Demographics
NPI:1063089472
Name:PATSOURAKOS, ELAINE N (LICSW)
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:N
Last Name:PATSOURAKOS
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 1:28 FREDRICKSON RD
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821-5312
Mailing Address - Country:US
Mailing Address - Phone:978-430-9527
Mailing Address - Fax:
Practice Address - Street 1:28 FREDRICKSON RD
Practice Address - Street 2:
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821-5312
Practice Address - Country:US
Practice Address - Phone:978-430-9527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-06
Last Update Date:2021-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1043351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty