Provider Demographics
NPI:1285919704
Name:ELLER, LIZABETH R (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:LIZABETH
Middle Name:R
Last Name:ELLER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 COMMERCIAL ST STE 214
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-4546
Mailing Address - Country:US
Mailing Address - Phone:503-325-7990
Mailing Address - Fax:
Practice Address - Street 1:750 COMMERCIAL ST STE 214
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-4546
Practice Address - Country:US
Practice Address - Phone:503-325-7990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-16
Last Update Date:2011-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL22121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical