Provider Demographics
NPI:1952633851
Name:OBEN, ELSA MARIE
Entity Type:Individual
Prefix:DR
First Name:ELSA
Middle Name:MARIE
Last Name:OBEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28844 RAINDANCE AVE
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-6422
Mailing Address - Country:US
Mailing Address - Phone:787-361-4173
Mailing Address - Fax:
Practice Address - Street 1:710 OAKFIELD DR
Practice Address - Street 2:SUITE 153
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4938
Practice Address - Country:US
Practice Address - Phone:813-654-0503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3479103T00000X
FLPY 9486103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPY 9486OtherLICENSED PSYCHOLOGIST
PR3479OtherLICENCIA