Healthcare Provider Details

I. General information

NPI: 1548074057
Provider Name (Legal Business Name): NADEZHDA ELLISON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5850 CANOGA AVE
WOODLAND HILLS CA
91367-6505
US

IV. Provider business mailing address

24007 ARCHWOOD ST
WEST HILLS CA
91307-3008
US

V. Phone/Fax

Practice location:
  • Phone: 510-917-0212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number144082
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: