Provider Demographics
NPI:1821398686
Name:LIDDELL, ELIZABETH ANN (LMHC)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANN
Last Name:LIDDELL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 DAMON RD
Mailing Address - Street 2:
Mailing Address - City:NEW WOODSTOCK
Mailing Address - State:NY
Mailing Address - Zip Code:13122-9722
Mailing Address - Country:US
Mailing Address - Phone:315-750-9131
Mailing Address - Fax:
Practice Address - Street 1:2509 DAMON RD
Practice Address - Street 2:
Practice Address - City:NEW WOODSTOCK
Practice Address - State:NY
Practice Address - Zip Code:13122-9722
Practice Address - Country:US
Practice Address - Phone:315-750-9131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18-002627101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health