Doctor Name: | MRS. ELIZABETH R NYBERG |
NPI Number: | 1154689693 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMHC |
License Number: | MH 11194 |
Business Practice Address: | 505 Brevard Ave 106 Cocoa, FL - 329227973 |
Business Phone Number: | 3216325792 |
Business Fax Number: | 3216325796 |
Mailing Address: | 505 Brevard Ave, 106 COCOA |
State: | FL |
Postal Code: | 329227973 |
Phone Number: | 3216325792 |
Fax Number: | 3216325796 |
NPI Enumeration Date: | 05/02/2012 |
NPI Last Update Date: | 07/08/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH 11194 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |