Provider Demographics
NPI:1396469862
Name:COLON-JAGDHARRY, LIZBETH (CPSS)
Entity type:Individual
Prefix:
First Name:LIZBETH
Middle Name:
Last Name:COLON-JAGDHARRY
Suffix:
Gender:F
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1052 JONES RD
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-6401
Mailing Address - Country:US
Mailing Address - Phone:530-392-2364
Mailing Address - Fax:
Practice Address - Street 1:201 D ST
Practice Address - Street 2:STE R & S
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-5952
Practice Address - Country:US
Practice Address - Phone:530-565-0972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-ZFCHTL175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist