Provider Demographics
NPI:1174884449
Name:POLCARO, ELIZABETH CLAIRE (LICSW)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:CLAIRE
Last Name:POLCARO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:CLAIRE
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:15 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:MA
Mailing Address - Zip Code:01749-2205
Mailing Address - Country:US
Mailing Address - Phone:508-298-1637
Mailing Address - Fax:
Practice Address - Street 1:15 SOUTH ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MA
Practice Address - Zip Code:01749-2205
Practice Address - Country:US
Practice Address - Phone:508-298-1637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-04
Last Update Date:2019-05-17
Deactivation Date:2018-07-31
Deactivation Code:
Reactivation Date:2018-08-15
Provider Licenses
StateLicense IDTaxonomies
222Q00000X, 252Y00000X
MA1202131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No252Y00000XAgenciesEarly Intervention Provider Agency