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General NPI Number Information
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NPI Number | 1548074057
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Entity Type | Individual
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Provider Name | NADEZHDA ELLISON
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Gender | Female
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Dates
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Enumeration Date | 02/04/2025
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 5850 CANOGA AVE
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City | WOODLAND HILLS
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State | CA
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Zip | 91367-6505
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Country | US
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Telephone | 510-917-0212
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Fax |
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Provider Business Mailing Address
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Address Line | 24007 ARCHWOOD ST
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City | WEST HILLS
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State | CA
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Zip | 91307-3008
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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 | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | 144082
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License Number State | CA
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