Provider Demographics
NPI:1194317750
Name:ELEVATE PSYCHOLOGICAL GROUP INC
Entity type:Organization
Organization Name:ELEVATE PSYCHOLOGICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SACK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:805-244-6919
Mailing Address - Street 1:80 WOOD RD STE 306
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-8312
Mailing Address - Country:US
Mailing Address - Phone:805-244-6919
Mailing Address - Fax:
Practice Address - Street 1:80 WOOD RD STE 306
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-8312
Practice Address - Country:US
Practice Address - Phone:805-244-6919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty