Provider Demographics
NPI:1942243845
Name:ALLEN, ELIZABETH K (PHD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:K
Last Name:ALLEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 SWEETWATER RD
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-7628
Mailing Address - Country:US
Mailing Address - Phone:619-327-0146
Mailing Address - Fax:619-327-0150
Practice Address - Street 1:1908 SWEETWATER RD
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-7628
Practice Address - Country:US
Practice Address - Phone:619-327-0146
Practice Address - Fax:619-327-0150
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20175103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP20175Medicare ID - Type Unspecified