Provider Demographics
NPI:1275752792
Name:HOWELL, ELIZABETH FABIAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:FABIAN
Last Name:HOWELL
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 1:111 HICKS ST
Mailing Address - Street 2:17D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1658
Mailing Address - Country:US
Mailing Address - Phone:718-797-5539
Mailing Address - Fax:718-797-5539
Practice Address - Street 1:817 BROADWAY
Practice Address - Street 2:9TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4709
Practice Address - Country:US
Practice Address - Phone:212-388-0926
Practice Address - Fax:718-797-5539
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007299103TC0700X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVIC763Medicare ID - Type Unspecified
NYVIC762Medicare ID - Type Unspecified