Provider Demographics
NPI:1093900102
Name:CORMAN, ELYSE I (MFT)
Entity Type:Individual
Prefix:MRS
First Name:ELYSE
Middle Name:I
Last Name:CORMAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4768 PARK GRANADA # 102
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1548
Mailing Address - Country:US
Mailing Address - Phone:818-317-8974
Mailing Address - Fax:
Practice Address - Street 1:4768 PARK GRANADA STE 102
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302
Practice Address - Country:US
Practice Address - Phone:818-914-1221
Practice Address - Fax:818-301-2351
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37359106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist