Provider Demographics
NPI:1174080634
Name:CORLEY, ELIZABETH F
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:F
Last Name:CORLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 S. WILLOW STREET
Mailing Address - Street 2:SUITE 266
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-5751
Mailing Address - Country:US
Mailing Address - Phone:877-315-8080
Mailing Address - Fax:877-345-4009
Practice Address - Street 1:373 S. WILLOW STREET SUITE 266
Practice Address - Street 2:SUITE 2
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-5751
Practice Address - Country:US
Practice Address - Phone:877-315-8080
Practice Address - Fax:877-345-4009
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALRBT-19-78781106S00000X
ALBACB468984103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician