Provider Demographics
NPI:1548664733
Name:REMINGTON, ELIZABETH (LAC, MS)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:REMINGTON
Suffix:
Gender:F
Credentials:LAC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 WALL ST
Mailing Address - Street 2:
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740
Mailing Address - Country:US
Mailing Address - Phone:732-241-9456
Mailing Address - Fax:
Practice Address - Street 1:199 WALL ST
Practice Address - Street 2:
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1167
Practice Address - Country:US
Practice Address - Phone:732-241-9456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-16
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00197600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional