Provider Demographics
NPI:1962095364
Name:ENDRIKAT, ELISABETH GRACE
Entity type:Individual
Prefix:DR
First Name:ELISABETH
Middle Name:GRACE
Last Name:ENDRIKAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1618
Mailing Address - Country:US
Mailing Address - Phone:732-920-3434
Mailing Address - Fax:732-920-2447
Practice Address - Street 1:58 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1618
Practice Address - Country:US
Practice Address - Phone:732-920-3434
Practice Address - Fax:732-920-2447
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00626300103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical