Provider Demographics
NPI:1730414764
Name:WARD, ELIZABETH R (PHD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:R
Last Name:WARD
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 1:74 EDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-2208
Mailing Address - Country:US
Mailing Address - Phone:914-627-8199
Mailing Address - Fax:
Practice Address - Street 1:4 CHATSWORTH AVE STE 202A
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-2946
Practice Address - Country:US
Practice Address - Phone:914-627-8199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-08
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019254103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical