Provider Demographics
NPI:1164676359
Name:JARVIE, ELIZABETH J (LCSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:JARVIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 HALL AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-1656
Mailing Address - Country:US
Mailing Address - Phone:715-732-7793
Mailing Address - Fax:715-732-7667
Practice Address - Street 1:2500 HALL AVE STE B
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-1656
Practice Address - Country:US
Practice Address - Phone:715-732-7793
Practice Address - Fax:715-732-7667
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7559-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical