Provider Demographics
NPI:1003026824
Name:PANGRAZZI, ELIZABETH (PSYD LP CAADC)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:PANGRAZZI
Suffix:
Gender:F
Credentials:PSYD LP CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 CARPENTER AVE
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-4722
Mailing Address - Country:US
Mailing Address - Phone:906-202-9444
Mailing Address - Fax:
Practice Address - Street 1:1102 CARPENTER AVE
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-4722
Practice Address - Country:US
Practice Address - Phone:906-202-9444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC-00560101YA0400X
MI6301018041103T00000X
WI6789-125101YP2500X
MI6301017266103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional