Provider Demographics
NPI:1619325230
Name:NGO, ELIZABETH (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:NGO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:VILLEMAIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:955 GOFFS FALLS RD STE 5422
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-9700
Mailing Address - Country:US
Mailing Address - Phone:603-682-8060
Mailing Address - Fax:603-383-5394
Practice Address - Street 1:230 AMHERST ST STE 107
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-1702
Practice Address - Country:US
Practice Address - Phone:603-682-8060
Practice Address - Fax:603-383-5394
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH21731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3117229Medicaid
NH3123057Medicaid