Provider Demographics
NPI:1508164153
Name:HARRISON, ELIZABETH A (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:HARRISON
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 1:501 GOODLETTE RD N
Mailing Address - Street 2:#D100
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5661
Mailing Address - Country:US
Mailing Address - Phone:239-649-1569
Mailing Address - Fax:800-595-3547
Practice Address - Street 1:501 GOODLETTE RD N
Practice Address - Street 2:#D100
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5661
Practice Address - Country:US
Practice Address - Phone:239-649-1569
Practice Address - Fax:800-595-3547
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW2214101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health