Provider Demographics
NPI:1538370085
Name:CRACCO, ELIZABETH JO-AN (PHD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:JO-AN
Last Name:CRACCO
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 1:86 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-2113
Mailing Address - Country:US
Mailing Address - Phone:860-963-7483
Mailing Address - Fax:
Practice Address - Street 1:161 MASHMOQUET RD
Practice Address - Street 2:
Practice Address - City:POMFRET CENTER
Practice Address - State:CT
Practice Address - Zip Code:06259-0191
Practice Address - Country:US
Practice Address - Phone:860-928-5904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002485103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist