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General NPI Number Information
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NPI Number | 1174894182
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Entity Type | Individual
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Provider Name | ELAINE JUDITH DE SIMONE RAS,CSC
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Gender | Female
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Dates
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Enumeration Date | 01/23/2012
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Last Update Date | 01/23/2012
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Provider Practice Location Address
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Address Line | 1636 WILSHIRE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90017-1627
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Country | US
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Telephone | 213-413-9122
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Fax | 213-413-9132
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Provider Business Mailing Address
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Address Line | 121 N MYERS ST
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City | BURBANK
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State | CA
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Zip | 91506-2314
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Country | US
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Telephone | 818-912-7747
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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