Provider Information for 1518304302
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ELAINE KATHRYN DERN L.C.S.W.
Sex: Female
NPI: 1518304302
Last Updated: 2013-06-03
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1518304302 | ||||||||
| Enumeration Date | 2013-06-03 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 8502 E CHAPMAN AVE SUITE 113 ORANGE, CA 92869-2461 United States Phone: 714-595-0606 | Fax: | ||||||||
| Primary Practice Address | 16585 PACIFIC COAST HWY SUITE 202 SUNSET BEACH, CA 90742 United States Phone: 714-595-0606 | Fax: | ||||||||
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