Provider Demographics
NPI:1457825333
Name:ELBERT, AUDREY (LMFT)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:ELBERT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 KENNEY ST APT B
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-7019
Mailing Address - Country:US
Mailing Address - Phone:203-715-6115
Mailing Address - Fax:
Practice Address - Street 1:35 N MAIN ST STE 2H
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-2577
Practice Address - Country:US
Practice Address - Phone:203-715-6115
Practice Address - Fax:203-718-6002
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2072106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist