Provider Demographics
NPI:1417571100
Name:TAYLOR, ELIZABETH DC (MS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DC
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:8 CASE ST
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:VT
Mailing Address - Zip Code:05733-1169
Mailing Address - Country:US
Mailing Address - Phone:802-989-1274
Mailing Address - Fax:
Practice Address - Street 1:THE GRANARY
Practice Address - Street 2:29 UNION STREET
Practice Address - City:BRANDON
Practice Address - State:VT
Practice Address - Zip Code:05733-0573
Practice Address - Country:US
Practice Address - Phone:802-989-1274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT047.0118917103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist