Provider Demographics
NPI:1922419050
Name:ANDERS, ELIZABETH RAY (PSY PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:RAY
Last Name:ANDERS
Suffix:
Gender:F
Credentials:PSY PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5944 S CHARITON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90056-1506
Mailing Address - Country:US
Mailing Address - Phone:213-595-2319
Mailing Address - Fax:
Practice Address - Street 1:5944 S CHARITON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90056-1506
Practice Address - Country:US
Practice Address - Phone:213-595-2319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 14697103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY 14697OtherCALIFORNIA BOARD OF PSYCHOLOGY