Provider Demographics
NPI:1598819732
Name:SLATER, ELIZABETH TRACE (PHD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:TRACE
Last Name:SLATER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-1914
Mailing Address - Country:US
Mailing Address - Phone:508-358-7555
Mailing Address - Fax:508-358-6685
Practice Address - Street 1:25 CONCORD RD
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-1914
Practice Address - Country:US
Practice Address - Phone:508-358-7555
Practice Address - Fax:508-358-6685
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPSY6736103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical