Provider Demographics
NPI:1306994934
Name:ISRAEL, EDITH (PSYD)
Entity type:Individual
Prefix:DR
First Name:EDITH
Middle Name:
Last Name:ISRAEL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 WARD RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-1832
Mailing Address - Country:US
Mailing Address - Phone:303-278-7418
Mailing Address - Fax:888-341-5050
Practice Address - Street 1:4730 TABLE MESA DR STE A100
Practice Address - Street 2:STE 102
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-5574
Practice Address - Country:US
Practice Address - Phone:303-444-3823
Practice Address - Fax:303-494-5720
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1539103T00000X
CO041106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist