Provider Demographics
NPI:1770503773
Name:LOEHFELM, ELIZABETH EILEEN (PHD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:EILEEN
Last Name:LOEHFELM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:LOEHFELM
Other - Last Name:HARTMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:25 JACQUELINE LN
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-4665
Mailing Address - Country:US
Mailing Address - Phone:508-747-2822
Mailing Address - Fax:508-747-0763
Practice Address - Street 1:71 COURT ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-3822
Practice Address - Country:US
Practice Address - Phone:508-747-2718
Practice Address - Fax:508-747-5209
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1824103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0504408Medicaid
MAW02467Medicare UPIN