Provider Demographics
NPI:1720612591
Name:BELEN, ELIZABETH (LADC, CASAC)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:BELEN
Suffix:
Gender:F
Credentials:LADC, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MASON ST
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418-1420
Mailing Address - Country:US
Mailing Address - Phone:347-761-4193
Mailing Address - Fax:
Practice Address - Street 1:15 MASON ST
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418-1420
Practice Address - Country:US
Practice Address - Phone:347-761-4193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001356101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)