Provider Demographics
NPI:1043601701
Name:SHOEMAKER, ELIZABETH ANDREA
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANDREA
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANDREA
Other - Last Name:SHOEMAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:5661 FAIRVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-8234
Mailing Address - Country:US
Mailing Address - Phone:850-981-1000
Mailing Address - Fax:
Practice Address - Street 1:5661 FAIRVIEW DR
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-8234
Practice Address - Country:US
Practice Address - Phone:850-981-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW116361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical