Individual
MRS. ELAINE MARY HALLISEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
63 WHEELER AVE, BROCKTON, MA 02301-3160
(508) 586-7518
Mailing address
63 WHEELER AVE, BROCKTON, MA 02301-3160
(508) 586-7518
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
1020588
MA
1041C0700X
Clinical Social Worker
Primary
1020588
MA
Other
Enumeration date
07/11/2012
Last updated
07/11/2012
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