Provider Demographics
NPI:1811255516
Name:SHOEMAKER, ELIZABETH ANN (LMFT)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:ANTONICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:533 NORTH NOVA ROAD SUITE 209
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-4447
Mailing Address - Country:US
Mailing Address - Phone:386-589-5610
Mailing Address - Fax:386-867-8119
Practice Address - Street 1:533 NORTH NOVA ROAD SUITE 209
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-4447
Practice Address - Country:US
Practice Address - Phone:386-589-5610
Practice Address - Fax:386-867-8119
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2252106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist