Provider Demographics
NPI:1386772663
Name:DORNAN-LIUZZO, ERIN LEIGH (PSYD)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:LEIGH
Last Name:DORNAN-LIUZZO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ERIN
Other - Middle Name:LEIGH
Other - Last Name:DORNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:18627 BROOKHURST ST # 194
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6748
Mailing Address - Country:US
Mailing Address - Phone:949-345-1186
Mailing Address - Fax:
Practice Address - Street 1:3151 AIRWAY AVE STE A2
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4620
Practice Address - Country:US
Practice Address - Phone:949-345-1186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23256103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical