Provider Demographics
NPI:1487756060
Name:REVELL, ELIZABETH SHEEHAN (PHD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:SHEEHAN
Last Name:REVELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 RANGE RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-8308
Mailing Address - Country:US
Mailing Address - Phone:717-840-1356
Mailing Address - Fax:717-840-8792
Practice Address - Street 1:1120 RANGE RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-8308
Practice Address - Country:US
Practice Address - Phone:717-840-1356
Practice Address - Fax:717-840-8792
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS 007447 L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPA 052331Medicare ID - Type Unspecified