Provider Demographics
NPI:1376949693
Name:MILAZZOTTO, ELIZABETH REDA (D MIN)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:REDA
Last Name:MILAZZOTTO
Suffix:
Gender:F
Credentials:D MIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3707
Mailing Address - Country:US
Mailing Address - Phone:502-983-9831
Mailing Address - Fax:502-896-0439
Practice Address - Street 1:3515 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3707
Practice Address - Country:US
Practice Address - Phone:502-983-9831
Practice Address - Fax:502-896-0439
Is Sole Proprietor?:No
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0021101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral