Provider Demographics
NPI:1023486651
Name:CACALI, ELYSSA GOODSIDE (PSYD)
Entity type:Individual
Prefix:
First Name:ELYSSA
Middle Name:GOODSIDE
Last Name:CACALI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SPECTRUM CENTER DR STE 1460
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4984
Mailing Address - Country:US
Mailing Address - Phone:949-478-2636
Mailing Address - Fax:
Practice Address - Street 1:300 SPECTRUM CENTER DR STE 1550
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3030
Practice Address - Country:US
Practice Address - Phone:949-478-2636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-14
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY31467172V00000X
CA31467103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No172V00000XOther Service ProvidersCommunity Health Worker