Provider Demographics
NPI:1093852816
Name:PANAGOULIS, ELIZABETH D (LCMHC)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:D
Last Name:PANAGOULIS
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 TEMPLE ST.
Mailing Address - Street 2:SUITE # 105
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060
Mailing Address - Country:US
Mailing Address - Phone:603-880-9880
Mailing Address - Fax:
Practice Address - Street 1:30 TEMPLE ST.
Practice Address - Street 2:SUITE # 105
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060
Practice Address - Country:US
Practice Address - Phone:603-880-9880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH15103T00000X
MA3330103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30007414Medicaid