Individual
MRS. ELIZABETH ANN IBSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, MSW
Contact information
Practice address
935 MAIN ST, SUITE 303, MANCHESTER, CT 06040-6059
(860) 645-4901
(860) 647-2932
Mailing address
935 MAIN ST, SUITE 303, MANCHESTER, CT 06040-6059
(860) 645-4901
(860) 647-2932
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
000425
CT
1041C0700X
Clinical Social Worker
Primary
002476
CT
Other
Enumeration date
11/15/2012
Last updated
11/15/2012
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