Provider Demographics
NPI:1053317586
Name:FOGARTY, ELIZABETH LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:LEE
Last Name:FOGARTY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 4TH AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15222-2120
Mailing Address - Country:US
Mailing Address - Phone:412-391-1816
Mailing Address - Fax:412-391-6640
Practice Address - Street 1:307 4TH AVE
Practice Address - Street 2:STE 300
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222-2120
Practice Address - Country:US
Practice Address - Phone:412-391-1816
Practice Address - Fax:412-391-6640
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002228L103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist