Provider Demographics
NPI:1366496291
Name:LAQUIDARA, ELIZABETH (PHD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:LAQUIDARA
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 1:7025 BERACASA WAY
Mailing Address - Street 2:STE 102B
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3428
Mailing Address - Country:US
Mailing Address - Phone:561-416-7338
Mailing Address - Fax:561-416-0203
Practice Address - Street 1:7025 BERACASA WAY
Practice Address - Street 2:102 B
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3443
Practice Address - Country:US
Practice Address - Phone:561-416-7338
Practice Address - Fax:561-416-0203
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5164103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59703ZMedicare PIN