Provider Demographics
NPI:1720137847
Name:YAMADA, ELAINE MIDORI (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:MIDORI
Last Name:YAMADA
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 1:4511 CLIFTON RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216-1646
Mailing Address - Country:US
Mailing Address - Phone:410-664-2031
Mailing Address - Fax:
Practice Address - Street 1:4511 CLIFTON RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-1646
Practice Address - Country:US
Practice Address - Phone:410-664-2031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00985103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD146071400Medicaid
MD7913 0001OtherFEP
MD002571OtherVALUEOPTIONS
MDG985EMOtherCAREFIRST BLUECROSS BLUES
G985Medicare ID - Type Unspecified