Provider Demographics
NPI:1023031663
Name:PAWLIKOWSKI, ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:PAWLIKOWSKI
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:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:SOUTH HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01075-0388
Mailing Address - Country:US
Mailing Address - Phone:413-538-9803
Mailing Address - Fax:
Practice Address - Street 1:97 WILLIAMSBURG RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:MA
Practice Address - Zip Code:01096-9721
Practice Address - Country:US
Practice Address - Phone:413-538-9803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2476103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW03153Medicare ID - Type Unspecified