Provider Demographics
NPI:1225651946
Name:EGGLESTON, ELIZABETH MARIE (LCSW, CASAC II)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARIE
Last Name:EGGLESTON
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Gender:F
Credentials:LCSW, CASAC II
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Mailing Address - Street 1:ST JOSEPH'S ADDICTION TREATMENT AND RECOVERY CENTERS
Mailing Address - Street 2:458 EAST MAIN ST
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953
Mailing Address - Country:US
Mailing Address - Phone:518-319-2388
Mailing Address - Fax:518-481-4213
Practice Address - Street 1:458 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-2149
Practice Address - Country:US
Practice Address - Phone:518-319-2388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2022-07-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1038901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical