Provider Demographics
NPI:1235454810
Name:SURACI, ELIZABETH (MS, LPC,NCC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:SURACI
Suffix:
Gender:F
Credentials:MS, LPC,NCC
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:
Other - Last Name:SURACI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS,LPC,NCC
Mailing Address - Street 1:172 FOUNTAIN ST
Mailing Address - Street 2:ELIZABETH SURACI
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515
Mailing Address - Country:US
Mailing Address - Phone:203-887-3251
Mailing Address - Fax:
Practice Address - Street 1:1302 CHAPEL ST
Practice Address - Street 2:AIDS PROJECT NEW HAVEN
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4515
Practice Address - Country:US
Practice Address - Phone:203-624-0947
Practice Address - Fax:203-401-4457
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000679101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional