Provider Demographics
NPI:1730592114
Name:DIGIOSE, ELIZABETH (MA, LPC, LCADC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:DIGIOSE
Suffix:
Gender:F
Credentials:MA, LPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 JUMPING BROOK RD.
Mailing Address - Street 2:BLDG 5, STE 201, ATTN: BEHAVIORAL HEALTH CREDENTIALING
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753
Mailing Address - Country:US
Mailing Address - Phone:732-643-4363
Mailing Address - Fax:
Practice Address - Street 1:661 SHREWSBURY AVE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4183
Practice Address - Country:US
Practice Address - Phone:732-643-4363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7797403OtherPROGRAM AGENCY MEDICAID
NJ0023701Medicaid