Provider Demographics
NPI:1265412175
Name:AUSTIN, ELIZABETH (PSYD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:
Other - Last Name:AUSTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:121 LINCOLN STREET
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2429
Mailing Address - Country:US
Mailing Address - Phone:508-755-2056
Mailing Address - Fax:508-755-0973
Practice Address - Street 1:121 LINCOLN STREET
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2429
Practice Address - Country:US
Practice Address - Phone:508-755-2056
Practice Address - Fax:508-755-0973
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7792103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0500372Medicaid
MA0500372Medicaid