Provider Demographics
NPI:1083616015
Name:KRAFCHUK, ELIZABETH E (PHD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:E
Last Name:KRAFCHUK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01951-1721
Mailing Address - Country:US
Mailing Address - Phone:978-465-0959
Mailing Address - Fax:
Practice Address - Street 1:28 GREEN ST
Practice Address - Street 2:
Practice Address - City:NEWBURY
Practice Address - State:MA
Practice Address - Zip Code:01951-1721
Practice Address - Country:US
Practice Address - Phone:978-465-0959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4036103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
W05288Medicare ID - Type Unspecified