Provider Demographics
NPI:1952926594
Name:ELIZABETH ANTALEK, MA, LICSW, PLLC
Entity Type:Organization
Organization Name:ELIZABETH ANTALEK, MA, LICSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTALEK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LICSW
Authorized Official - Phone:603-988-9114
Mailing Address - Street 1:275 HIGHLAND ST APT 3
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-5118
Mailing Address - Country:US
Mailing Address - Phone:603-988-9114
Mailing Address - Fax:
Practice Address - Street 1:16 FRANKLIN ST # C
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-2819
Practice Address - Country:US
Practice Address - Phone:603-988-9114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health