Provider Demographics
NPI:1275677502
Name:SPARROW, ELIZABETH P (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:P
Last Name:SPARROW
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20382
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27619-0382
Mailing Address - Country:US
Mailing Address - Phone:410-905-4607
Mailing Address - Fax:
Practice Address - Street 1:N CAROLINA STATE UNIVERSITY
Practice Address - Street 2:DEPARTMENT OF PSYCHOLOGY, BOX 7650
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27695-0001
Practice Address - Country:US
Practice Address - Phone:410-905-4607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03955103G00000X, 103TC0700X, 103TC2200X, 103T00000X, 103TM1800X
NC3756103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities