Provider Demographics
NPI:1174654867
Name:NADLE, ELIZABETH B (PSYD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:B
Last Name:NADLE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 UNION AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-3628
Mailing Address - Country:US
Mailing Address - Phone:732-528-8544
Mailing Address - Fax:
Practice Address - Street 1:147 UNION AVE
Practice Address - Street 2:SUITE C
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-3628
Practice Address - Country:US
Practice Address - Phone:732-528-8544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4015103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist