Provider Demographics
NPI:1982327284
Name:JABLON, ELANA MICHELLE (PHD)
Entity Type:Individual
Prefix:
First Name:ELANA
Middle Name:MICHELLE
Last Name:JABLON
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 1:376 N SAN VICENTE BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1810
Mailing Address - Country:US
Mailing Address - Phone:310-927-7229
Mailing Address - Fax:
Practice Address - Street 1:23332 HAWTHORNE BLVD STE 304
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4457
Practice Address - Country:US
Practice Address - Phone:424-215-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty