Provider Demographics
NPI:1669564027
Name:ONUFRAK, ELIZABETH (PHD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:ONUFRAK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 W ROYAL PALM RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-5665
Mailing Address - Country:US
Mailing Address - Phone:602-787-8000
Mailing Address - Fax:
Practice Address - Street 1:8102 N 23RD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-4962
Practice Address - Country:US
Practice Address - Phone:602-242-7383
Practice Address - Fax:602-242-7387
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3260103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0615660OtherBCBSAZ PROVIDER #