MEDICARE: ELIZABETH DINGUS M.S., NCSP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist	1335377	NY

General Provider Information

NPI Number	:	1669897633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH DINGUS M.S., NCSP

Provider Business Mailing Address
First Line	:	16 LIVERPOOL HTS
Second Line	:
City	:	NORTH CHILI
State	:	NY
Zip	:	14514-9811
Country	:	US
Telephone Number	:	585-880-0403
Fax Number	:

Provider Business Practice Location Address
First Line	:	16 LIVERPOOL HTS
Second Line	:
City	:	NORTH CHILI
State	:	NY
Zip	:	14514-9811
Country	:	US
Telephone Number	:	585-880-0403
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2014
Last Update Date	:	02/26/2014

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