Provider Demographics
NPI:1437433158
Name:RICHARD, ELIZABETH PAGE
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:PAGE
Last Name:RICHARD
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 1:1225 CRANE ST. SUITE 205
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-1136
Mailing Address - Country:US
Mailing Address - Phone:650-319-7225
Mailing Address - Fax:
Practice Address - Street 1:1225 CRANE ST. SUITE 205
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-1136
Practice Address - Country:US
Practice Address - Phone:650-319-7225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program