Provider Demographics
NPI:1457682833
Name:NGUYEN, ELIZABETH ROZETTE (MA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ROZETTE
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:JOANN
Other - Last Name:ROZETTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:1620 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-3904
Mailing Address - Country:US
Mailing Address - Phone:610-799-8222
Mailing Address - Fax:
Practice Address - Street 1:1620 BROADWAY
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-3904
Practice Address - Country:US
Practice Address - Phone:610-799-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-25
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006980L103T00000X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103T00000XBehavioral Health & Social Service ProvidersPsychologist