1477887230 NPI number — MRS. ELIZABETH DIANE STRAYHORN LCSW

Table of content: MRS. ELIZABETH DIANE STRAYHORN LCSW (NPI 1477887230)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477887230 NPI number — MRS. ELIZABETH DIANE STRAYHORN LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STRAYHORN
Provider First Name:
ELIZABETH
Provider Middle Name:
DIANE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477887230
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 WILLARD WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ITHACA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14850-3833
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-973-0862
Provider Business Mailing Address Fax Number:
724-935-6044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 E. STATE ST.
Provider Second Line Business Practice Location Address:
SUITE 411
Provider Business Practice Location Address City Name:
ITHACA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14850-5578
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-973-0862
Provider Business Practice Location Address Fax Number:
724-935-6044
Provider Enumeration Date:
09/28/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  CW016401 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: LICENSE#078527-1 CER , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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