Provider Demographics
NPI:1003972357
Name:NEAL, ELIZABETH CARBERY
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CARBERY
Last Name:NEAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6222 SCOTT HWY
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:VT
Mailing Address - Zip Code:05046-7609
Mailing Address - Country:US
Mailing Address - Phone:802-584-3939
Mailing Address - Fax:
Practice Address - Street 1:242 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-2644
Practice Address - Country:US
Practice Address - Phone:802-748-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000069101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT4953OtherBLUE CROSS BLUE SHEILD
VT1007119Medicaid
VT2032044OtherCIGNA