Provider Demographics
NPI:1134246176
Name:DEPELTEAU, ELIZABETH ERIN (PSYD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ERIN
Last Name:DEPELTEAU
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 VALENTINE ST
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3127
Mailing Address - Country:US
Mailing Address - Phone:321-586-5444
Mailing Address - Fax:321-319-9712
Practice Address - Street 1:1335 VALENTINE ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3127
Practice Address - Country:US
Practice Address - Phone:321-586-5444
Practice Address - Fax:321-319-9712
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLPY7694103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002984900Medicaid
FL74442OtherBCBSFL
FL002984900Medicaid