Provider Demographics
NPI:1336290162
Name:LORD, ELIZABETH K (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:K
Last Name:LORD
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 1:2 SYCAMORE CT N
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34446-4534
Mailing Address - Country:US
Mailing Address - Phone:352-476-7444
Mailing Address - Fax:352-382-9014
Practice Address - Street 1:2 SYCAMORE CT N
Practice Address - Street 2:
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34446-4534
Practice Address - Country:US
Practice Address - Phone:352-476-7444
Practice Address - Fax:352-382-9014
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW6946101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL764608900Medicaid