Healthcare Provider Details

I. General information

NPI: 1740190453
Provider Name (Legal Business Name): ELIZABETH BATISTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 MAIN ST S BLDG 2
SOUTHBURY CT
06488-4253
US

IV. Provider business mailing address

8 DEVON CT
MIDDLEBURY CT
06762-3337
US

V. Phone/Fax

Practice location:
  • Phone: 203-525-2475
  • Fax:
Mailing address:
  • Phone: 203-525-2475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9906
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: