Provider Demographics
NPI:1457601973
Name:ESTWICK, ELIZABETH (MSED)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:ESTWICK
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 PRINCETON BLVD APT 17
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-2065
Mailing Address - Country:US
Mailing Address - Phone:347-234-2058
Mailing Address - Fax:
Practice Address - Street 1:740 PRINCETON BLVD APT 17
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-2065
Practice Address - Country:US
Practice Address - Phone:347-234-2058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2015-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY644927121174400000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor