Provider Demographics
NPI:1013136571
Name:PADDOCK, ELIZABETH STARR (MA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:STARR
Last Name:PADDOCK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 IRIS AVE
Mailing Address - Street 2:HOME BASED SERVICES
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-2226
Mailing Address - Country:US
Mailing Address - Phone:720-406-3662
Mailing Address - Fax:720-406-3654
Practice Address - Street 1:1333 IRIS AVE
Practice Address - Street 2:HOME BASED SERVICES
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-2226
Practice Address - Country:US
Practice Address - Phone:720-406-3662
Practice Address - Fax:720-406-3654
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health