Provider Demographics
NPI:1033300876
Name:CANTWELL, ELIZABETH A (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:CANTWELL
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 TOBIN DR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:DE
Mailing Address - Zip Code:19968-1526
Mailing Address - Country:US
Mailing Address - Phone:516-313-5146
Mailing Address - Fax:
Practice Address - Street 1:402 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:DE
Practice Address - Zip Code:19968
Practice Address - Country:US
Practice Address - Phone:516-313-5146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
DEO1-0001604235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor