Provider Demographics
NPI:1023128642
Name:NACE, ELIZABETH (LCSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:NACE
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 1:342 HARBOR ST
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-4540
Mailing Address - Country:US
Mailing Address - Phone:203-481-4248
Mailing Address - Fax:209-483-7727
Practice Address - Street 1:342 HARBOR ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-4540
Practice Address - Country:US
Practice Address - Phone:203-481-4248
Practice Address - Fax:209-483-7727
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0034721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT10447667OtherC.A.Q.H.
CT140003472CT01OtherANTHEM
CT140003472CT01OtherANTHEM