| Doctor Name: | MS. ELISABETH ELLIS WAINGROW |
| NPI Number: | 1811045537 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW, LICSW |
| License Number: | 104093 |
| Business Practice Address: | 24 Lincoln St Newton Highlands, MA - 024611524 |
| Business Phone Number: | 6172448132 |
| Business Fax Number: | |
| Mailing Address: | P.o. Box 610094, NEWTON HIGHLANDS |
| State: | MA |
| Postal Code: | 024610094 |
| Phone Number: | 6172448132 |
| Fax Number: | |
| NPI Enumeration Date: | 01/08/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 104093 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |