Provider Demographics
NPI:1033269253
Name:HARTZELL, ELIZABETH ANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANNE
Last Name:HARTZELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:BETTY
Other - Middle Name:ANNE
Other - Last Name:HARTZELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:220 W EVERGREEN AVE
Mailing Address - Street 2:B31
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-3862
Mailing Address - Country:US
Mailing Address - Phone:215-242-8769
Mailing Address - Fax:
Practice Address - Street 1:255 S 17TH ST
Practice Address - Street 2:SUITE 1405
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6231
Practice Address - Country:US
Practice Address - Phone:215-732-6308
Practice Address - Fax:215-732-8240
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002871101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health