Provider Demographics
NPI:1720039852
Name:HOSTERMAN, ELIZABETH J (MA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:HOSTERMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1848 CHARTER LANE
Mailing Address - Street 2:LIFE MANAGEMENT ASSOCIATES
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-5896
Mailing Address - Country:US
Mailing Address - Phone:717-394-6688
Mailing Address - Fax:717-394-6804
Practice Address - Street 1:845 SILVER SPRING PLACE
Practice Address - Street 2:LIFE MANAGEMENT ASSOCIATES
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-5896
Practice Address - Country:US
Practice Address - Phone:717-394-6688
Practice Address - Fax:717-394-6804
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005721L103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
188842OtherVALUE OPTIONS
PA01710302OtherCAPITAL BLUE CROSS