Provider Demographics
NPI:1366463622
Name:VAN LEER, ELIZABETH JO (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:JO
Last Name:VAN LEER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 PARK ST
Mailing Address - Street 2:NEW HAVEN
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1109
Mailing Address - Country:US
Mailing Address - Phone:203-974-7639
Mailing Address - Fax:203-974-7637
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:NEW HAVEN
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-415-2066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0061171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical