Provider Demographics
NPI:1760872972
Name:NITSCH, ELIZABETH (PSYD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:NITSCH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2627 NE 203RD ST
Mailing Address - Street 2:#100
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1900
Mailing Address - Country:US
Mailing Address - Phone:786-657-2084
Mailing Address - Fax:
Practice Address - Street 1:2627 NE 203RD ST
Practice Address - Street 2:#100
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33180-1900
Practice Address - Country:US
Practice Address - Phone:786-657-2084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9169103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical