Provider Demographics
NPI:1497182422
Name:MCBRIDE, ELIZABETH A (MA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:A
Other - Last Name:MCBRIDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 844
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-0844
Mailing Address - Country:US
Mailing Address - Phone:310-480-5387
Mailing Address - Fax:
Practice Address - Street 1:312 ROCKY POINT RD
Practice Address - Street 2:
Practice Address - City:PALOS VERDES ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-2624
Practice Address - Country:US
Practice Address - Phone:310-480-5387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85872106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist