Provider Demographics
NPI:1497788582
Name:NASSER, ELIZABETH HOLLE (PHD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:HOLLE
Last Name:NASSER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532-2072
Mailing Address - Country:US
Mailing Address - Phone:508-259-7684
Mailing Address - Fax:508-393-1903
Practice Address - Street 1:22 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-2072
Practice Address - Country:US
Practice Address - Phone:508-259-7684
Practice Address - Fax:508-393-1903
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8127-PR103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA641611OtherTUFTS
MAW06270OtherBLUE CROSS BLUE SHIELD
MA0502731Medicaid
MA641611OtherTUFTS
MAUX9475Medicare PIN