Provider Demographics
NPI:1598977639
Name:ELIOT, STEPHEN VICTOR (PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:VICTOR
Last Name:ELIOT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 KINGS HIGHWAY NORTH
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-2444
Mailing Address - Country:US
Mailing Address - Phone:203-222-9029
Mailing Address - Fax:203-226-8865
Practice Address - Street 1:162 KINGS HIGHWAY NORTH
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-2444
Practice Address - Country:US
Practice Address - Phone:203-222-9029
Practice Address - Fax:203-226-8865
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT592103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis