Provider Demographics
NPI:1316356652
Name:SOMSANITH, ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:SOMSANITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4700 WISSAHICKON AVENUE
Mailing Address - Street 2:BLDG D, SUITE 118
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144
Mailing Address - Country:US
Mailing Address - Phone:267-597-3600
Mailing Address - Fax:267-597-3622
Practice Address - Street 1:4700 WISSAHICKON AVE
Practice Address - Street 2:BLDG D, SUITE 118
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-4248
Practice Address - Country:US
Practice Address - Phone:267-597-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0176601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical