MEDICARE: ELIZABETH GARRISON

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	103K00000X	Behavior Analyst	1-10-6876

General Provider Information

NPI Number	:	1598098071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH GARRISON

Provider Business Mailing Address
First Line	:	2702 W MORELAND RD
Second Line	:
City	:	WILLOW GROVE
State	:	PA
Zip	:	19090-3024
Country	:	US
Telephone Number	:	215-694-9766
Fax Number	:

Provider Business Practice Location Address
First Line	:	2702 W MORELAND RD
Second Line	:
City	:	WILLOW GROVE
State	:	PA
Zip	:	19090-3024
Country	:	US
Telephone Number	:	215-694-9766
Fax Number	:

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

Provider Enumeration Date	:	09/15/2009
Last Update Date	:	07/21/2010

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Directions to “ ELIZABETH GARRISON ” Practice Location

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