Healthcare Provider Details

I. General information

NPI: 1194294181
Provider Name (Legal Business Name): BETSY ELSASSER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 11/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

379 6TH AVE W
BRADENTON FL
34205-8820
US

IV. Provider business mailing address

379 6TH AVE W
BRADENTON FL
34205-8820
US

V. Phone/Fax

Practice location:
  • Phone: 941-782-4150
  • Fax: 941-782-4301
Mailing address:
  • Phone: 941-782-4150
  • Fax: 941-782-4301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY10306
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: