Provider Demographics
NPI:1295851608
Name:DATTILIO, ELIZABETH (LPCC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:DATTILIO
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:769 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-1740
Mailing Address - Country:US
Mailing Address - Phone:330-424-9573
Mailing Address - Fax:330-424-0877
Practice Address - Street 1:45875 BELL SCHOOL RD STE B
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-8728
Practice Address - Country:US
Practice Address - Phone:330-397-6007
Practice Address - Fax:234-254-5655
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0003175101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0184853Medicaid