Provider Demographics
NPI:1477887230
Name:STRAYHORN, ELIZABETH DIANE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:DIANE
Last Name:STRAYHORN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 WILLARD WAY
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-3833
Mailing Address - Country:US
Mailing Address - Phone:412-973-0862
Mailing Address - Fax:724-935-6044
Practice Address - Street 1:202 E. STATE ST.
Practice Address - Street 2:SUITE 411
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5578
Practice Address - Country:US
Practice Address - Phone:412-973-0862
Practice Address - Fax:724-935-6044
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-28
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0164011041C0700X
NYLICENSE#078527-1 CER1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical