Provider Demographics
NPI:1477083376
Name:DECKER, ELIZABETH KING (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KING
Last Name:DECKER
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CROSS RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:OLD GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06870-1101
Mailing Address - Country:US
Mailing Address - Phone:203-505-8404
Mailing Address - Fax:
Practice Address - Street 1:237 TACONIC RD
Practice Address - Street 2:GREENWICH CENTER FOR HOPE AND RENEWAL
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831
Practice Address - Country:US
Practice Address - Phone:203-505-8404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001849106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT81-509-8610OtherIRS INDIVIDUAL TAXPAYER IDENTIFICATION NUMBER