Provider Demographics
NPI:1871206573
Name:MOUNT, ELIZABETH (LAC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MOUNT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 W LAUREL RD
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08084-1717
Mailing Address - Country:US
Mailing Address - Phone:856-357-5568
Mailing Address - Fax:
Practice Address - Street 1:6102 HAMILTON WAY
Practice Address - Street 2:
Practice Address - City:EASTAMPTON TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08060-1673
Practice Address - Country:US
Practice Address - Phone:484-515-6125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00697900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health