Provider Demographics
NPI:1164015392
Name:ELIZABETH H FELL-DEWALT PSYCHOLOGY PLLC
Entity Type:Organization
Organization Name:ELIZABETH H FELL-DEWALT PSYCHOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:HELEN
Authorized Official - Last Name:FELL-DEWALT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:607-737-6051
Mailing Address - Street 1:1605 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:PINE CITY
Mailing Address - State:NY
Mailing Address - Zip Code:14871-9732
Mailing Address - Country:US
Mailing Address - Phone:607-737-6051
Mailing Address - Fax:
Practice Address - Street 1:330 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-2602
Practice Address - Country:US
Practice Address - Phone:607-727-1220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty