Provider Demographics
NPI:1669789913
Name:MAMOURIAN CORONA, ELISABETH C (LCSW)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:C
Last Name:MAMOURIAN CORONA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELISABETH
Other - Middle Name:C
Other - Last Name:MAMOURIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2058 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:EAST PETERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17520-1202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:283 BUTLER RD # 550
Practice Address - Street 2:
Practice Address - City:MOUNT GRETNA
Practice Address - State:PA
Practice Address - Zip Code:17064-6085
Practice Address - Country:US
Practice Address - Phone:717-273-8871
Practice Address - Fax:717-273-8871
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0177401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical