Provider Demographics
NPI:1679807143
Name:VERNA STIVALA, ELIZABETH (ATR-BC, LCAT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:VERNA STIVALA
Suffix:
Gender:F
Credentials:ATR-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E BROADWAY
Mailing Address - Street 2:#2E
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:210 E BROADWAY
Practice Address - Street 2:#2E
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-4216
Practice Address - Country:US
Practice Address - Phone:516-909-1774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000978102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst