Individual ProviderElizabeth DavenportSocial WorkerBehavioral Health & Social Service ProvidersPractice Address740 Main St, Suite #105, Waltham, MA 02451(781) 937-4172(781) 862-4907PECOS EnrollmentBased on the most recent information from CMS, provider Elizabeth Davenport does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 10:04 AM.Profile DetailsProvider ID1497818116Provider TypeIndividualFull NameDavenport, ElizabethCredentialLICSWGenderFemaleSole ProprietorNoEnumeration Date12/18/2006Last Updated7/8/2007Contact InformationPractice LocationPractice Address740 Main St, Suite #105, Waltham, MA 02451Phone(781) 937-4172Fax(781) 734-0482Mailing LocationMailing Address4 Angier Rd, Lexington, MA 02420Phone(781) 862-4907FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense100214MassachusettsProvider IdentifiersIDDescriptionIssuerIDP04346DescriptionOtherIssuerBLUE CROSS BLUE SHIELD