Provider Demographics
NPI:1811259088
Name:CARRION, ELIZABETH THEODORA (MSED)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:THEODORA
Last Name:CARRION
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15035 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-1549
Mailing Address - Country:US
Mailing Address - Phone:917-579-4788
Mailing Address - Fax:
Practice Address - Street 1:15035 28TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-1549
Practice Address - Country:US
Practice Address - Phone:917-579-4788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist