Healthcare Provider Details

I. General information

NPI: 1053796763
Provider Name (Legal Business Name): ELIZABETH C CLOSE LMHC-D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2015
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7447 THOMPSON RD
NORTH SYRACUSE NY
13212-2536
US

IV. Provider business mailing address

7447 THOMPSON RD
NORTH SYRACUSE NY
13212-2536
US

V. Phone/Fax

Practice location:
  • Phone: 315-545-6226
  • Fax:
Mailing address:
  • Phone: 315-545-6226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number007995
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: