Provider Demographics
NPI:1447239009
Name:BOYAJIAN, ELIZABETH (MED, LMHC LCPC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BOYAJIAN
Suffix:
Gender:F
Credentials:MED, LMHC LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ANGEL PL
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530-1691
Mailing Address - Country:US
Mailing Address - Phone:207-505-0777
Mailing Address - Fax:207-729-7277
Practice Address - Street 1:63 E ELM STREET
Practice Address - Street 2:FELDSPAR MILL
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086
Practice Address - Country:US
Practice Address - Phone:207-505-0777
Practice Address - Fax:207-729-7277
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA144101YP2500X
ME3300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALM1258OtherBLUE CROSSBLUE SHIELD
2649500OtherCIGNA BEHAVIORAL HEALTH