Provider Demographics
NPI:1619128121
Name:DE ALMEIDA, ELIAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIAS
Middle Name:
Last Name:DE ALMEIDA
Suffix:
Gender:M
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:PO BOX 119
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95696-0119
Mailing Address - Country:US
Mailing Address - Phone:707-474-4296
Mailing Address - Fax:
Practice Address - Street 1:419 MASON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-4546
Practice Address - Country:US
Practice Address - Phone:707-474-4296
Practice Address - Fax:707-447-1990
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20146103T00000X
IDLMFT 2921106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist