Provider Demographics
NPI:1972569325
Name:PETEGORSKY, ELIZABETH MORRISON (LICSW CEAP LADC)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:MORRISON
Last Name:PETEGORSKY
Suffix:
Gender:F
Credentials:LICSW CEAP LADC
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:D
Other - Last Name:MORRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW CEAP LADC
Mailing Address - Street 1:172 NORTH FARMS ROAD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062
Mailing Address - Country:US
Mailing Address - Phone:413-584-0999
Mailing Address - Fax:
Practice Address - Street 1:19 CENTER CT
Practice Address - Street 2:SUITE 2A
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3006
Practice Address - Country:US
Practice Address - Phone:413-297-5644
Practice Address - Fax:413-584-9915
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1135101YA0400X
MA10154291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP04900OtherBLUE CROSS BLUE SHIELD
56264OtherCIGNA HEALTH CARE
P04900OtherBCBS OUT OF STATE
56264OtherCIGNA BEHAVIORAL HEALTH
35392OtherHEALTH NEW ENGLAND
56264OtherCIGNA BEHAVIORAL HEALTH E
MAP04900OtherBLUE CROSS BLUE SHIELD