Provider Demographics
NPI:1932987880
Name:ANDERSON, ELIZABETH JAYNE (PHD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:JAYNE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:BETTY
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:6767 N WICKHAM RD STE 306
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-2025
Mailing Address - Country:US
Mailing Address - Phone:321-751-1925
Mailing Address - Fax:
Practice Address - Street 1:6767 N WICKHAM RD STE 306
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2025
Practice Address - Country:US
Practice Address - Phone:321-751-1925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY12974103T00000X
FL385103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist