Provider Demographics
NPI:1265631170
Name:RATHBUN, ELIZABETH IRENE (LPC, PSYD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:IRENE
Last Name:RATHBUN
Suffix:
Gender:F
Credentials:LPC, PSYD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:IRENE
Other - Last Name:EMPRIMO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, PSYD
Mailing Address - Street 1:357 WHITNEY AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2364
Mailing Address - Country:US
Mailing Address - Phone:203-974-2062
Mailing Address - Fax:
Practice Address - Street 1:357 WHITNEY AVE STE 206
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-2364
Practice Address - Country:US
Practice Address - Phone:203-974-2062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6299101YM0800X
CTLPC#001628101YP2500X
CT3887103TC0700X
CT003887103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional