Provider Demographics
NPI:1780782433
Name:MAURY, ELIZABETH HALLORAN (PHD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:HALLORAN
Last Name:MAURY
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 1:33 FREEMONT AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-5731
Mailing Address - Country:US
Mailing Address - Phone:301-920-1087
Mailing Address - Fax:301-920-1087
Practice Address - Street 1:1107 SPRING ST
Practice Address - Street 2:SUITE A2
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4027
Practice Address - Country:US
Practice Address - Phone:301-920-1102
Practice Address - Fax:301-920-1087
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 6342103TC0700X
MD04288103TC0700X
DCPSY1000405103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL63421Medicare ID - Type UnspecifiedCA MEDICARE PROVIDER #