Provider Demographics
NPI:1851304091
Name:WALDHEIM, ELIZABETH J (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:J
Last Name:WALDHEIM
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 1:16935 W BERNARDO DR
Mailing Address - Street 2:SUITE 170
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-1634
Mailing Address - Country:US
Mailing Address - Phone:858-452-1044
Mailing Address - Fax:858-925-7654
Practice Address - Street 1:16935 W BERNARDO DR
Practice Address - Street 2:SUITE 170
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-1634
Practice Address - Country:US
Practice Address - Phone:858-452-1044
Practice Address - Fax:858-925-7654
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12471103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PSY12471AMedicare UPIN