Provider Demographics
NPI:1255682035
Name:BROWN, ELIZABETH ZVINGILAS (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ZVINGILAS
Last Name:BROWN
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 839
Mailing Address - Street 2:1007 NORTH MAIN STREET
Mailing Address - City:DAYVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06241-0839
Mailing Address - Country:US
Mailing Address - Phone:860-774-2020
Mailing Address - Fax:
Practice Address - Street 1:303 PUTNAM ROAD
Practice Address - Street 2:
Practice Address - City:WAUREGAN
Practice Address - State:CT
Practice Address - Zip Code:06387-0378
Practice Address - Country:US
Practice Address - Phone:860-412-8686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1-11-8914103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004040564Medicaid