Provider Demographics
NPI:1790047025
Name:PETERS, ELIZABETH (MSED, BCBA,LBA)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:MSED, BCBA,LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CANTERBURY RD
Mailing Address - Street 2:APT #2F
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2121
Mailing Address - Country:US
Mailing Address - Phone:516-524-9294
Mailing Address - Fax:
Practice Address - Street 1:16 CANTERBURY RD
Practice Address - Street 2:APT #2F
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2121
Practice Address - Country:US
Practice Address - Phone:516-524-9294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1734981174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist