Provider Demographics
NPI:1053664524
Name:MYERS, ELIZABETH LAVENSON (PHD,)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LAVENSON
Last Name:MYERS
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 1:1157 FAIR WEATHER CIR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-1939
Mailing Address - Country:US
Mailing Address - Phone:925-459-0173
Mailing Address - Fax:
Practice Address - Street 1:1157 FAIR WEATHER CIR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-1939
Practice Address - Country:US
Practice Address - Phone:925-459-0173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9862103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical