Provider Demographics
NPI:1538348107
Name:BOETSCH, ELIZABETH A (PHD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:A
Last Name:BOETSCH
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:PO BOX 44
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-0044
Mailing Address - Country:US
Mailing Address - Phone:207-236-8385
Mailing Address - Fax:207-236-0655
Practice Address - Street 1:21 ELM ST
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:CAMDEN
Practice Address - State:ME
Practice Address - Zip Code:04843-1949
Practice Address - Country:US
Practice Address - Phone:207-236-8385
Practice Address - Fax:207-236-0655
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS965103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent