Provider Demographics
NPI:1528167665
Name:SOCCORSO, ELIZABETH-ANN (APRN)
Entity type:Individual
Prefix:
First Name:ELIZABETH-ANN
Middle Name:
Last Name:SOCCORSO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 POWERS ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-2748
Mailing Address - Country:US
Mailing Address - Phone:978-922-3000
Mailing Address - Fax:978-524-6072
Practice Address - Street 1:100 POWERS ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-2748
Practice Address - Country:US
Practice Address - Phone:978-922-3000
Practice Address - Fax:978-524-6072
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA129052163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0300080Medicaid
MA0300080Medicaid
MANS0449Medicare ID - Type UnspecifiedMEDICARE PROVIDER