Provider Demographics
NPI:1841903747
Name:LORING, ELIZABETH JEANNETTE
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JEANNETTE
Last Name:LORING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 MAIN ST APT G3
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-4258
Mailing Address - Country:US
Mailing Address - Phone:203-509-1716
Mailing Address - Fax:
Practice Address - Street 1:500 E MAIN ST STE 322
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-2929
Practice Address - Country:US
Practice Address - Phone:203-535-3021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6030101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional