Individual
ELIZABETH ANN PUTELIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
330 SW CUTOFF STE 203, WORCESTER, MA 01604-2730
(508) 341-2829
Mailing address
105 WALLACE AVE, AUBURN, MA 01501-1103
(508) 981-1930
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103K00000X
Behavior Analyst
Primary
2047
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000023532
BMC
MA
01
—
042611055
TAX ID
MA
01
—
1004745
NHP
MA
01
—
1303287
MBHP
MA
05
—
1303287
—
MA
01
—
99618201
NETWORK HEALTH
MA
01
—
M18633
BCBS
MA
Enumeration date
05/24/2012
Last updated
04/03/2018
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