Healthcare Provider Details

I. General information

NPI: 1639487077
Provider Name (Legal Business Name): ELIZABETH ROSE CARSON PSY.D., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2010
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12711 VENTURA BLVD STE 160
STUDIO CITY CA
91604-2476
US

IV. Provider business mailing address

12711 VENTURA BLVD STE 160
STUDIO CITY CA
91604-2476
US

V. Phone/Fax

Practice location:
  • Phone: 818-971-9590
  • Fax:
Mailing address:
  • Phone: 818-971-9590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-17-25680
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: