Provider Demographics
NPI:1720361207
Name:HALPER, ELIZABETH B (PH D)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:B
Last Name:HALPER
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:B
Other - Last Name:HALPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PH D
Mailing Address - Street 1:10560 MAIN ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7182
Mailing Address - Country:US
Mailing Address - Phone:703-988-4990
Mailing Address - Fax:703-988-4990
Practice Address - Street 1:10560 MAIN ST
Practice Address - Street 2:SUITE 211
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7182
Practice Address - Country:US
Practice Address - Phone:703-988-4990
Practice Address - Fax:703-988-4990
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004473103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical