MEDICARE: ELIZABETH C CLOSE LMHC-D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	007995	NY

General Provider Information

NPI Number	:	1053796763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH C CLOSE LMHC-D

Provider Business Mailing Address
First Line	:	7447 THOMPSON RD
Second Line	:
City	:	NORTH SYRACUSE
State	:	NY
Zip	:	13212-2536
Country	:	US
Telephone Number	:	315-545-6226
Fax Number	:

Provider Business Practice Location Address
First Line	:	7447 THOMPSON RD
Second Line	:
City	:	NORTH SYRACUSE
State	:	NY
Zip	:	13212-2536
Country	:	US
Telephone Number	:	315-545-6226
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2015
Last Update Date	:	05/08/2026

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