Provider Demographics
NPI:1871751883
Name:BADILLO, ELIZABETH LEE DORN (LCSW)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:LEE DORN
Last Name:BADILLO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1350 TAMIAMI TRL N STE 202
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5209
Mailing Address - Country:US
Mailing Address - Phone:239-224-3577
Mailing Address - Fax:239-214-6131
Practice Address - Street 1:1350 TAMIAMI TRL N STE 202
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5209
Practice Address - Country:US
Practice Address - Phone:239-224-3577
Practice Address - Fax:239-214-6131
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 114791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical