Provider Demographics
NPI:1700297561
Name:NABEL, ELAINE (PSYD)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:NABEL
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 1:546 MORENO AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-4839
Mailing Address - Country:US
Mailing Address - Phone:310-963-0122
Mailing Address - Fax:
Practice Address - Street 1:11022 SANTA MONICA BLVD STE 370
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7532
Practice Address - Country:US
Practice Address - Phone:310-963-0122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
CAPSY31018103T00000X
NY022899-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY31018OtherCA STATE PSYCHOLOGY LICENSE
NY022899-1OtherNY STATE PSYCHOLOGY LICENSE