Provider Demographics
NPI:1942478425
Name:GINSBURG, ELISE SUSANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELISE
Middle Name:SUSANNE
Last Name:GINSBURG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ELISE
Other - Middle Name:GINSBURG
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:255 CANYON BLVD STE 200
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-4954
Mailing Address - Country:US
Mailing Address - Phone:303-945-5311
Mailing Address - Fax:720-638-3699
Practice Address - Street 1:255 CANYON BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-4979
Practice Address - Country:US
Practice Address - Phone:303-945-5311
Practice Address - Fax:720-638-3699
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-18
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3125103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical