Provider Demographics
NPI:1770465122
Name:MARJORAM, ELIZABETH JOY (RBT, CPR)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JOY
Last Name:MARJORAM
Suffix:
Gender:F
Credentials:RBT, CPR
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:JOY
Other - Last Name:LESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:419 S STONE ST
Mailing Address - Street 2:
Mailing Address - City:WEST SUFFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06093-3220
Mailing Address - Country:US
Mailing Address - Phone:931-316-5406
Mailing Address - Fax:
Practice Address - Street 1:114 MAIN ST STE G
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06118-3211
Practice Address - Country:US
Practice Address - Phone:888-754-0398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VABACB1241584106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician