Individual
ELIZABETH JEAN NOLAN-STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
205 BURLINGTON RD, BEDFORD, MA 01730-1406
(781) 761-5077
Mailing address
205 BURLINGTON RD, BEDFORD, MA 01730-1406
(781) 761-5077
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
MA
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000023532
BMC
MA
01
—
042611055
TAXID
MA
01
—
1004745
NHP
MA
01
—
1303287
MBHP
MA
05
—
1303287
—
MA
01
—
99618201
NETWORK HEALTH
MA
01
—
M18633
BCBS
MA
Enumeration date
02/29/2012
Last updated
11/04/2020
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