Healthcare Provider Details

I. General information

NPI: 1659675858
Provider Name (Legal Business Name): ELIZABETH GERRITT SCHOOL PSYCHOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2011
Last Update Date: 01/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 LAKEVIEW AVE
MILFORD DE
19963-1732
US

IV. Provider business mailing address

906 LAKEVIEW AVE
MILFORD DE
19963-1732
US

V. Phone/Fax

Practice location:
  • Phone: 302-684-4950
  • Fax: 302-684-8931
Mailing address:
  • Phone: 302-684-4950
  • Fax: 302-684-8931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number54722
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: