Provider Demographics
NPI:1710053582
Name:ROUMASSET, ELLEN GRACE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:GRACE
Last Name:ROUMASSET
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 1:901 CAMPUS DR
Mailing Address - Street 2:STE 301
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-4900
Mailing Address - Country:US
Mailing Address - Phone:650-994-6925
Mailing Address - Fax:650-994-6925
Practice Address - Street 1:901 CAMPUS DR
Practice Address - Street 2:STE 301
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-4900
Practice Address - Country:US
Practice Address - Phone:650-994-6925
Practice Address - Fax:650-994-6925
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13033103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL130330Medicare ID - Type UnspecifiedPROVIDER ID