Provider Demographics
NPI:1609499888
Name:ANTHONY, ELIZABETH R (LSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:R
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 LAKELAND AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-5714
Mailing Address - Country:US
Mailing Address - Phone:404-323-6046
Mailing Address - Fax:
Practice Address - Street 1:19035 OLD DETROIT RD STE 202
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-1750
Practice Address - Country:US
Practice Address - Phone:440-638-5933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-22
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2004859104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker