Provider Demographics
NPI:1265640452
Name:KRANTZ, ELLEN SHEILA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:SHEILA
Last Name:KRANTZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:KRANTZ
Other - Last Name:WEISS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 TAMAL PLZ
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1125
Mailing Address - Country:US
Mailing Address - Phone:415-927-3800
Mailing Address - Fax:415-927-3809
Practice Address - Street 1:100 TAMAL PLZ
Practice Address - Street 2:SUITE 102
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1125
Practice Address - Country:US
Practice Address - Phone:415-927-3800
Practice Address - Fax:415-927-3809
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 16681103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist