Provider Demographics
NPI:1821204371
Name:HARRISON, ELISE Z (LMFT)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:Z
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 DWIGHT ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6626
Mailing Address - Country:US
Mailing Address - Phone:203-255-0076
Mailing Address - Fax:203-255-0076
Practice Address - Street 1:115 DWIGHT ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6626
Practice Address - Country:US
Practice Address - Phone:203-255-0076
Practice Address - Fax:203-255-0076
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000259106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist