Healthcare Provider Details

I. General information

NPI: 1053247486
Provider Name (Legal Business Name): MRS. ELIZABETH ANNE FRISSORA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 HARTFORD TPKE
VERNON CT
06066-5017
US

IV. Provider business mailing address

610 TRAILS END RD
MANCHESTER CT
06042-7110
US

V. Phone/Fax

Practice location:
  • Phone: 860-870-5997
  • Fax:
Mailing address:
  • Phone: 917-854-3361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2365
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: