Provider Demographics
NPI:1447280441
Name:WARE, ELIZABETH P (PH D)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:P
Last Name:WARE
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:H
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1064
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530-1064
Mailing Address - Country:US
Mailing Address - Phone:207-443-1166
Mailing Address - Fax:207-443-1160
Practice Address - Street 1:48 FRONT ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-2524
Practice Address - Country:US
Practice Address - Phone:207-522-2930
Practice Address - Fax:207-443-1187
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS 1185103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432188200Medicaid