Provider Demographics
NPI:1083743850
Name:MARGOLIS, ELLEN BETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:BETH
Last Name:MARGOLIS
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 1:3551 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4815
Mailing Address - Country:US
Mailing Address - Phone:619-295-7094
Mailing Address - Fax:619-291-0158
Practice Address - Street 1:3551 FRONT ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4815
Practice Address - Country:US
Practice Address - Phone:619-295-7094
Practice Address - Fax:619-291-0158
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7301103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY7301OtherMEDICAL UD NUMBER
CAPSY7301OtherMEDICAL UD NUMBER