Provider Demographics
NPI:1558416966
Name:GANIRON, ELISABETH ELLEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELISABETH
Middle Name:ELLEN
Last Name:GANIRON
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 1:1644 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-2204
Mailing Address - Country:US
Mailing Address - Phone:559-871-3617
Mailing Address - Fax:805-752-1128
Practice Address - Street 1:310 JAMES WAY STE 110
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:559-871-3617
Practice Address - Fax:805-752-1128
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22623103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical