Healthcare Provider Details

I. General information

NPI: 1124088992
Provider Name (Legal Business Name): ELIZABETH LOVICK CASSCLES PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 ROUTE 385
CATSKILL NY
12414-6018
US

IV. Provider business mailing address

308 ROUTE 385
CATSKILL NY
12414-6018
US

V. Phone/Fax

Practice location:
  • Phone: 518-755-2803
  • Fax:
Mailing address:
  • Phone: 518-755-2803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number010417
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number010417
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: