Provider Demographics
NPI:1194547653
Name:NUSSBAUM, ELIABETH (EDS, NCSP)
Entity type:Individual
Prefix:
First Name:ELIABETH
Middle Name:
Last Name:NUSSBAUM
Suffix:
Gender:F
Credentials:EDS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 UTICA-SELLERSBURG RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130
Mailing Address - Country:US
Mailing Address - Phone:812-288-4840
Mailing Address - Fax:812-288-4896
Practice Address - Street 1:2112 UTICA-SELLERSBURG RD
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130
Practice Address - Country:US
Practice Address - Phone:812-288-4840
Practice Address - Fax:812-288-4896
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1565876103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool