Provider Demographics
NPI:1588634125
Name:PEDERSEN, ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:BETSY
Other - Middle Name:
Other - Last Name:PEDERSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:UNC DEPT OF FAMILY MEDICINE
Mailing Address - Street 2:CB# 7586
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-0001
Mailing Address - Country:US
Mailing Address - Phone:919-966-4671
Mailing Address - Fax:919-966-6125
Practice Address - Street 1:104 S ESTES DR STE 206
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2866
Practice Address - Country:US
Practice Address - Phone:919-966-4671
Practice Address - Fax:919-966-6125
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist