Provider Demographics
NPI:1669860839
Name:PAVONE, ELIZABETH (LMFT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:PAVONE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 WEST AZEELE STREET
Mailing Address - Street 2:#337
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-3368
Mailing Address - Country:US
Mailing Address - Phone:813-250-1303
Mailing Address - Fax:
Practice Address - Street 1:2320 WEST AZEELE STREET
Practice Address - Street 2:#337
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3368
Practice Address - Country:US
Practice Address - Phone:813-250-1303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2769106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist