Healthcare Provider Details

I. General information

NPI: 1730878844
Provider Name (Legal Business Name): ELIZABETH MUMMAU PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W 14TH ST BLDG 5TH
WILMINGTON DE
19801-1013
US

IV. Provider business mailing address

501 W 14TH ST BLDG 5TH
WILMINGTON DE
19801-1013
US

V. Phone/Fax

Practice location:
  • Phone: 302-320-2620
  • Fax: 302-320-2683
Mailing address:
  • Phone: 302-320-2620
  • Fax: 302-320-2683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberB1-0011507
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberB1-0011507
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: