Provider Demographics
NPI:1164483749
Name:FLAVELL, ELIZABETH R (MSW LICSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:R
Last Name:FLAVELL
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Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2910 CENTRE POINTE DR
Mailing Address - Street 2:35-121A
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113
Mailing Address - Country:US
Mailing Address - Phone:651-855-2327
Mailing Address - Fax:651-855-2310
Practice Address - Street 1:347 N SMITH AVE
Practice Address - Street 2:CHILDRENS SPECIALTY CLINIC PSYCHOLOGICAL SERVICES STPL
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:651-220-6720
Practice Address - Fax:651-220-6707
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN026591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical