Provider Demographics
NPI:1649593559
Name:VANGELIST, ELIZABETH A
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:VANGELIST
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 1:255 LOW ST STE 302
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-3596
Mailing Address - Country:US
Mailing Address - Phone:978-222-3121
Mailing Address - Fax:978-296-3460
Practice Address - Street 1:255 LOW ST STE 302
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3596
Practice Address - Country:US
Practice Address - Phone:978-222-3121
Practice Address - Fax:978-296-3460
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-05
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MALMHC8363101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health