Provider Demographics
NPI:1447507652
Name:FOSTER, ELIZABETH K (MED, BCBA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:K
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 VIRGINIA HIGHLANDS
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-8233
Mailing Address - Country:US
Mailing Address - Phone:845-489-2012
Mailing Address - Fax:
Practice Address - Street 1:445 VIRGINIA HIGHLANDS
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-8233
Practice Address - Country:US
Practice Address - Phone:845-489-2012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst