Provider Demographics
NPI:1245467612
Name:GIAMMARCO, ELIZABETH SALLY (LCPCC, PHD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:SALLY
Last Name:GIAMMARCO
Suffix:
Gender:F
Credentials:LCPCC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SWALLOW DR
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-8201
Mailing Address - Country:US
Mailing Address - Phone:207-894-5389
Mailing Address - Fax:
Practice Address - Street 1:11 SWALLOW DR
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-8201
Practice Address - Country:US
Practice Address - Phone:207-894-5389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-12
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL2981101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional