Provider Demographics
NPI:1629493473
Name:MENAKER, ELIZABETH GRACE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:GRACE
Last Name:MENAKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1940 W DICKERSON ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6851
Mailing Address - Country:US
Mailing Address - Phone:917-207-9763
Mailing Address - Fax:406-587-2292
Practice Address - Street 1:1940 W DICKERSON ST
Practice Address - Street 2:SUITE 102
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6851
Practice Address - Country:US
Practice Address - Phone:917-207-9763
Practice Address - Fax:406-587-2292
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-03
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY087906-1104100000X
MT122721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker