Provider Demographics
NPI:1083207286
Name:ELIZABETH CIARAVINO, PH.D.
Entity Type:Organization
Organization Name:ELIZABETH CIARAVINO, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CIARAVINO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:570-226-0851
Mailing Address - Street 1:13 COMANCHE DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18438-6773
Mailing Address - Country:US
Mailing Address - Phone:570-226-0851
Mailing Address - Fax:
Practice Address - Street 1:8 SILK MILL DR STE 223
Practice Address - Street 2:
Practice Address - City:HAWLEY
Practice Address - State:PA
Practice Address - Zip Code:18428-1423
Practice Address - Country:US
Practice Address - Phone:570-226-1963
Practice Address - Fax:570-226-1967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-18
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1154425205Medicaid