Provider Demographics
NPI:1609904184
Name:STIFF, ELIZABETH BALLIET (MSW)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:BALLIET
Last Name:STIFF
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 SCARBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-1864
Mailing Address - Country:US
Mailing Address - Phone:302-645-0115
Mailing Address - Fax:
Practice Address - Street 1:16529 COASTAL HWY
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-3605
Practice Address - Country:US
Practice Address - Phone:302-645-0115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00000071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000021562Medicaid
DE491109Medicare ID - Type Unspecified