Provider Demographics
NPI:1437209707
Name:ANCOLI-ISRAEL, SONIA (PHD)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:ANCOLI-ISRAEL
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 1:200 WEST ARBOR DRIVE
Mailing Address - Street 2:MC-8384
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-8384
Mailing Address - Country:US
Mailing Address - Phone:619-543-5713
Mailing Address - Fax:619-543-7427
Practice Address - Street 1:200 WEST ARBOR DRIVE
Practice Address - Street 2:MC-8384
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-8384
Practice Address - Country:US
Practice Address - Phone:619-543-5713
Practice Address - Fax:619-543-7427
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7431103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical