Provider Demographics
NPI:1700800349
Name:WERTH, ELAINE B (PHD)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:B
Last Name:WERTH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 SHERIDAN BLVD
Mailing Address - Street 2:STE 1
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-6100
Mailing Address - Country:US
Mailing Address - Phone:402-489-1834
Mailing Address - Fax:402-489-2046
Practice Address - Street 1:301 W 7TH ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-4460
Practice Address - Country:US
Practice Address - Phone:402-489-1834
Practice Address - Fax:402-489-2046
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE488103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical