Provider Demographics
NPI:1497715601
Name:DRITSAS, DENISE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:
Last Name:DRITSAS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 JAMES WAY STE 150
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-2877
Mailing Address - Country:US
Mailing Address - Phone:805-586-3250
Mailing Address - Fax:559-241-0486
Practice Address - Street 1:310 JAMES WAY STE 150
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-2877
Practice Address - Country:US
Practice Address - Phone:805-586-3250
Practice Address - Fax:805-586-3250
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17428103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist