Provider Demographics
NPI:1083016703
Name:DAMON, ELIZABETH ROSE (LPC, R-DMT)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ROSE
Last Name:DAMON
Suffix:
Gender:F
Credentials:LPC, R-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 GRASMERE AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6153
Mailing Address - Country:US
Mailing Address - Phone:207-415-3842
Mailing Address - Fax:
Practice Address - Street 1:4021 MAIN ST
Practice Address - Street 2:1F
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-3568
Practice Address - Country:US
Practice Address - Phone:207-415-3842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002611101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional