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General NPI Number Information
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NPI Number | 1245798016
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Entity Type | Individual
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Provider Name | YOUSSEF ELMANAWY PHD. LAADC.
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Gender | Male
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Dates
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Enumeration Date | 03/11/2019
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Last Update Date | 11/29/2023
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Provider Practice Location Address
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Address Line | 1525 UNION AVE
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City | FAIRFIELD
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State | CA
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Zip | 94533-5049
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Country | US
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Telephone | 707-435-1804
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Fax |
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Provider Business Mailing Address
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Address Line | 606 WAXWING PL
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City | DAVIS
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State | CA
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Zip | 95616-7526
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Country | US
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Telephone |
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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 | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | LCI04511115
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCI04511115
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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