Provider Demographics
NPI:1568003283
Name:FUDGE, ELIZABETH KELIAR (LMFT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KELIAR
Last Name:FUDGE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:KELIAR
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33 POKORNY RD
Mailing Address - Street 2:
Mailing Address - City:HIGGANUM
Mailing Address - State:CT
Mailing Address - Zip Code:06441-4461
Mailing Address - Country:US
Mailing Address - Phone:203-605-1502
Mailing Address - Fax:203-407-1309
Practice Address - Street 1:56 WHITING ST #846
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062
Practice Address - Country:US
Practice Address - Phone:860-368-8665
Practice Address - Fax:203-407-1309
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2125106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist