Provider Demographics
NPI:1699979542
Name:MATERN, ELIZABETH RUEL (MD PSYCHIATRIST)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:RUEL
Last Name:MATERN
Suffix:
Gender:F
Credentials:MD PSYCHIATRIST
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:MARY
Other - Last Name:RUEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:40 DALE ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001
Mailing Address - Country:US
Mailing Address - Phone:860-676-9350
Mailing Address - Fax:860-678-7178
Practice Address - Street 1:40 DALE ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001
Practice Address - Country:US
Practice Address - Phone:860-676-9350
Practice Address - Fax:860-678-7178
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243816208000000X, 2084P0800X, 2084P0804X
CT0480272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FRI360647OtherDEA