Provider Demographics
NPI:1710075692
Name:SCHNEIDER, ELISABETH TULLIS (LMFT)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:TULLIS
Last Name:SCHNEIDER
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 1:171 BIRCH RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6722
Mailing Address - Country:US
Mailing Address - Phone:203-921-6559
Mailing Address - Fax:
Practice Address - Street 1:5 BROOK ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4549
Practice Address - Country:US
Practice Address - Phone:203-921-6559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CT001230106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004172920Medicaid