Provider Demographics
NPI:1588831010
Name:MAYER, ELIZABETH A
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:A
Last Name:MAYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5467 UPPER MOUNTAIN ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-1895
Mailing Address - Country:US
Mailing Address - Phone:716-439-7410
Mailing Address - Fax:716-439-7418
Practice Address - Street 1:1001 ELEVENTH STREET
Practice Address - Street 2:TROTT ACCESS CENTER
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301
Practice Address - Country:US
Practice Address - Phone:716-278-1940
Practice Address - Fax:716-278-1943
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072849104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker