Provider Demographics
NPI:1205143237
Name:EDDY, ELIZABETH DIONNE (MS)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DIONNE
Last Name:EDDY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 DAILY AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLEROI
Mailing Address - State:PA
Mailing Address - Zip Code:15022-3111
Mailing Address - Country:US
Mailing Address - Phone:724-255-6318
Mailing Address - Fax:724-489-4947
Practice Address - Street 1:81 WALTER LONG DR
Practice Address - Street 2:
Practice Address - City:FINLEYVILLE
Practice Address - State:PA
Practice Address - Zip Code:15332
Practice Address - Country:US
Practice Address - Phone:724-255-6318
Practice Address - Fax:724-489-4947
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003193101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional