Provider Demographics
NPI:1508077819
Name:DRISCOLL-JORGENSEN, ELIZABETH DRISCOLL (CADC)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:DRISCOLL
Last Name:DRISCOLL-JORGENSEN
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 DANBURY RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4105
Mailing Address - Country:US
Mailing Address - Phone:203-431-9726
Mailing Address - Fax:203-438-3824
Practice Address - Street 1:103 DANBURY RD
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4105
Practice Address - Country:US
Practice Address - Phone:203-431-9726
Practice Address - Fax:203-438-3824
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000110101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health