Provider Demographics
NPI:1275885527
Name:DIMOVSKI-JACKSON, ELIZABETH BETI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:BETI
Last Name:DIMOVSKI-JACKSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12758 EDGEMONT WAY
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7296
Mailing Address - Country:US
Mailing Address - Phone:317-774-4752
Mailing Address - Fax:
Practice Address - Street 1:1905 S NEW MARKET ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7396
Practice Address - Country:US
Practice Address - Phone:317-774-4752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0006353103TC0700X
FLPY11607103TC0700X
IN20048162A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical