Healthcare Provider Details

I. General information

NPI: 1356771083
Provider Name (Legal Business Name): ELIJAH AMIR COHEN-SAPERSTEIN PSY.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2013
Last Update Date: 09/12/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 BEECH STREET SUITE 2203
SAN DIEGO CA
92101
US

IV. Provider business mailing address

PO BOX 120951
SAN DIEGO CA
92112-0951
US

V. Phone/Fax

Practice location:
  • Phone: 917-981-0503
  • Fax:
Mailing address:
  • Phone: 917-981-0503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License NumberIL-2013399
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberIL-2013399
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: