Provider Demographics
NPI:1699559831
Name:ELIZABETH DRISCOLL, PHD LLC
Entity type:Organization
Organization Name:ELIZABETH DRISCOLL, PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:DRISCOLL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:617-863-7303
Mailing Address - Street 1:100 LONG POND ROAD
Mailing Address - Street 2:PO BOX 1517
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-9998
Mailing Address - Country:US
Mailing Address - Phone:617-863-7303
Mailing Address - Fax:
Practice Address - Street 1:9 RIVER BIRCH WAY
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-6702
Practice Address - Country:US
Practice Address - Phone:617-863-7303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health