Provider Demographics
NPI:1437180692
Name:PRESTON, ELIZABETH A (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:A
Last Name:PRESTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4100 REDWOOD RD STE 10
Mailing Address - Street 2:#126
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-2363
Mailing Address - Country:US
Mailing Address - Phone:510-482-5344
Mailing Address - Fax:510-531-0915
Practice Address - Street 1:1305 FRANKLIN ST STE 509
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3224
Practice Address - Country:US
Practice Address - Phone:510-482-5344
Practice Address - Fax:510-531-0915
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12735103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical