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General NPI Number Information
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NPI Number | 1568848950
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Entity Type | Individual
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Provider Name | ELIZABETH ANNE NORRIS-WALCZAK PHD
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Gender | Female
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Dates
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Enumeration Date | 08/07/2015
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Last Update Date | 03/10/2019
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Provider Practice Location Address
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Address Line | 13701 RIVERSIDE DR STE 409
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City | SHERMAN OAKS
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State | CA
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Zip | 91423-2448
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Country | US
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Telephone | 626-371-0064
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1651
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City | BORREGO SPRINGS
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State | CA
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Zip | 92004-1651
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Country | US
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Telephone | 805-612-9865
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 27117
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License Number State | CA
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