Healthcare Provider Details

I. General information

NPI: 1477795243
Provider Name (Legal Business Name): ELIZABETH SAUNDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2009
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 HATFIELD ST
NORTHAMPTON MA
01060-1556
US

IV. Provider business mailing address

6 HATFIELD ST
NORTHAMPTON MA
01060-1556
US

V. Phone/Fax

Practice location:
  • Phone: 413-584-7425
  • Fax: 413-584-7440
Mailing address:
  • Phone: 413-584-7425
  • Fax: 413-584-7440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5454
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1034AD
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: