Provider Demographics
NPI:1164240743
Name:VAIL, ELIZABETH T (LEP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:T
Last Name:VAIL
Suffix:
Gender:F
Credentials:LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 CAMERON RD
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3902
Mailing Address - Country:US
Mailing Address - Phone:719-650-0631
Mailing Address - Fax:
Practice Address - Street 1:37 CAMERON RD
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3902
Practice Address - Country:US
Practice Address - Phone:719-650-0631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1051103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool