Provider Demographics
NPI:1073707097
Name:FINEBERG, ELLEN JOAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:JOAN
Last Name:FINEBERG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SHAVANA
Other - Middle Name:
Other - Last Name:FINEBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 474
Mailing Address - Street 2:
Mailing Address - City:WILLIAMS
Mailing Address - State:OR
Mailing Address - Zip Code:97544-0474
Mailing Address - Country:US
Mailing Address - Phone:541-846-0590
Mailing Address - Fax:541-846-0590
Practice Address - Street 1:217 NE C ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-2153
Practice Address - Country:US
Practice Address - Phone:541-846-0590
Practice Address - Fax:541-846-0590
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-03
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1698103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical