Provider Demographics
NPI:1801941026
Name:ERNSDORF, WALTER STEPHEN (PHD)
Entity type:Individual
Prefix:MR
First Name:WALTER
Middle Name:STEPHEN
Last Name:ERNSDORF
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:229 CALLE MARINA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92677
Mailing Address - Country:US
Mailing Address - Phone:949-495-8853
Mailing Address - Fax:949-495-7686
Practice Address - Street 1:30131 TOWN CENTER DR
Practice Address - Street 2:SUITE 280
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677
Practice Address - Country:US
Practice Address - Phone:949-495-8853
Practice Address - Fax:949-495-7686
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10594103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist