Provider Demographics
NPI:1942603998
Name:JUCEVICS, ELIZABETH I (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:I
Last Name:JUCEVICS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1774
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-1774
Mailing Address - Country:US
Mailing Address - Phone:860-485-5459
Mailing Address - Fax:
Practice Address - Street 1:412 W AVON RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-2500
Practice Address - Country:US
Practice Address - Phone:860-485-5459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008741251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health