Provider Demographics
NPI:1881315406
Name:QVALE, ELISE
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:QVALE
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 1:9269 SILVER GLEN WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-4798
Mailing Address - Country:US
Mailing Address - Phone:561-632-0605
Mailing Address - Fax:
Practice Address - Street 1:5090 S HAVERHILL RD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-5901
Practice Address - Country:US
Practice Address - Phone:561-493-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor