Provider Demographics
NPI:1790859312
Name:PAULEY, ELSA P (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELSA
Middle Name:P
Last Name:PAULEY
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:PO BOX 492030
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-8030
Mailing Address - Country:US
Mailing Address - Phone:310-550-1449
Mailing Address - Fax:310-471-8931
Practice Address - Street 1:11655 TERRYHILL PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-4401
Practice Address - Country:US
Practice Address - Phone:310-550-1449
Practice Address - Fax:310-471-8931
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10997103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY109970Medicaid
CAPSY109972Medicaid
CAPSY109971Medicaid
CAPSY109970Medicaid
CACP10997BMedicare ID - Type Unspecified
CAPSY109972Medicaid
CACP10997CMedicare ID - Type Unspecified
CAPSY109971Medicaid