Provider Demographics
NPI:1790412419
Name:DURAN ODEN, LIZBETH G
Entity Type:Individual
Prefix:
First Name:LIZBETH
Middle Name:G
Last Name:DURAN ODEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 ELM ST APT A
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03470-3111
Mailing Address - Country:US
Mailing Address - Phone:661-586-3874
Mailing Address - Fax:
Practice Address - Street 1:2 MECHANIC ST STE 1-6
Practice Address - Street 2:
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-1562
Practice Address - Country:US
Practice Address - Phone:413-540-1210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-03
Last Update Date:2023-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No174400000XOther Service ProvidersSpecialist