Elizabeth Bourquin, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

9130 Issued in CT

Practice address

406 Farmington Ave Ste 1
Farmington, CT 06032-1964

Phone

(860) 677-3950

Fax

(860) 724-4397

NPI assigned

Jul 24, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Hartford Healthcare Medical Group, Inc

  • Durable Medical Equipment & Medical Supplies
  • Farmington, CT
  • NPI 1720140221
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1532390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658880000000",
    "number": "1629555479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1290 SILAS DEANE HWY",
            "address_2": "HARTFORD HEALTHCARE-CVO",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061094337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 FARMINGTON AVE STE 1",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060321964",
            "telephone_number": "860-677-3950",
            "fax_number": "860-724-4397"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Simsbury Rd Ste 203",
            "address_purpose": "LOCATION",
            "city": "Avon",
            "state": "CT",
            "postal_code": "060013793",
            "country_code": "US",
            "telephone_number": "860-696-4460",
            "fax_number": "860-724-4381",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOURQUIN",
        "first_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-07-24",
        "last_updated": "2022-07-27",
        "certification_date": "2022-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "9130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Juan Esteban Borja Ceballos, MD
• Penney Borovsky, SLP
• Bharti Joy Bouffard, LMSW
• Nayla Boulad, D.O
• Ashley E. Bourassa, APRN, NNP-BC
• Jourdan S Bowe
• David K. Bowers, MD
• Kylie Marie Boyle
• Allison Nicole Bradford, DO
• Colleen Brady, DPT

• Clinical Social Worker in Farmington, CT
• Providers in Farmington, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.