Healthcare Provider Details

I. General information

NPI: 1770757916
Provider Name (Legal Business Name): ELIZABETH F PALEY HSP-PA, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 09/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 GREENVILLE BLVD SE SUITE B1
GREENVILLE NC
27858-5758
US

IV. Provider business mailing address

308 GREENVILLE BLVD SE SUITE B-1
GREENVILLE NC
27858-5758
US

V. Phone/Fax

Practice location:
  • Phone: 262-341-4192
  • Fax: 866-309-9297
Mailing address:
  • Phone: 252-341-4192
  • Fax: 866-309-9297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number2401
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number2401
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number1-04-1807
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-04-1807
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: