Provider Demographics
NPI:1154425205
Name:CIARAVINO, ELIZABETH (PH D)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:CIARAVINO
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SILK MILL DR STE 223
Mailing Address - Street 2:
Mailing Address - City:HAWLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18428-1423
Mailing Address - Country:US
Mailing Address - Phone:570-226-1963
Mailing Address - Fax:570-226-1967
Practice Address - Street 1:8 SILK MILL DR STE 223
Practice Address - Street 2:
Practice Address - City:HAWLEY
Practice Address - State:PA
Practice Address - Zip Code:18428-1423
Practice Address - Country:US
Practice Address - Phone:570-226-1963
Practice Address - Fax:570-226-1967
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007724L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
187970OtherMAN
803770OtherFIRST PRIORITY
638739Medicare ID - Type Unspecified