Provider Demographics
NPI:1952679102
Name:CRUICKSHANK, ELIZABETH A (LPC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:CRUICKSHANK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 OLD FURNACE RD
Mailing Address - Street 2:
Mailing Address - City:RIEGELSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18077-9551
Mailing Address - Country:US
Mailing Address - Phone:610-730-7572
Mailing Address - Fax:
Practice Address - Street 1:281 OLD FURNACE RD
Practice Address - Street 2:
Practice Address - City:RIEGELSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18077-9551
Practice Address - Country:US
Practice Address - Phone:610-730-7572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-02
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00491000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional