Provider Demographics
NPI:1124273131
Name:TEMPLETON, ELIZABETH MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARIE
Last Name:TEMPLETON
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 1:75 FENWOOD RD
Mailing Address - Street 2:MASS. MENTAL HEALTH CENTER
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6103
Mailing Address - Country:US
Mailing Address - Phone:617-626-9464
Mailing Address - Fax:617-626-9578
Practice Address - Street 1:75 FENWOOD RD
Practice Address - Street 2:MASS. MENTAL HEALTH CENTER
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6103
Practice Address - Country:US
Practice Address - Phone:617-626-9464
Practice Address - Fax:617-626-9578
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1156131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical