Provider Demographics
NPI:1689904617
Name:PARSONS, ELIZABETH PAIGE (PHD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:PAIGE
Last Name:PARSONS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 123
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLYMOUTH
Mailing Address - State:NY
Mailing Address - Zip Code:13844-0123
Mailing Address - Country:US
Mailing Address - Phone:518-701-0145
Mailing Address - Fax:
Practice Address - Street 1:505 CLUBHOUSE RD
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850
Practice Address - Country:US
Practice Address - Phone:607-249-5028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-14
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108456-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ300115268Medicare PIN