Healthcare Provider Details

I. General information

NPI: 1154517720
Provider Name (Legal Business Name): ELIZABETH WHITE CUORATO LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 09/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 N PROVIDENCE RD
MEDIA PA
19063-1404
US

IV. Provider business mailing address

1033 N PROVIDENCE RD
MEDIA PA
19063-1404
US

V. Phone/Fax

Practice location:
  • Phone: 610-566-4975
  • Fax:
Mailing address:
  • Phone: 610-566-4975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMF000026
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: