Provider Demographics
NPI:1811223126
Name:ELMORE, FLORENCE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:FLORENCE
Middle Name:
Last Name:ELMORE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:FLORIE
Other - Middle Name:
Other - Last Name:ELMORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:902 EUREKA AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-3615
Mailing Address - Country:US
Mailing Address - Phone:510-847-6991
Mailing Address - Fax:
Practice Address - Street 1:1621 OAK AVE
Practice Address - Street 2:SUITE B
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-1000
Practice Address - Country:US
Practice Address - Phone:510-847-6991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 21721103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical