Provider Demographics
NPI:1396146569
Name:CHADWICK, ELLIOTT (PMHNP)
Entity type:Individual
Prefix:
First Name:ELLIOTT
Middle Name:
Last Name:CHADWICK
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 S ST LOUIS ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-4320
Mailing Address - Country:US
Mailing Address - Phone:323-261-4900
Mailing Address - Fax:
Practice Address - Street 1:560 S ST LOUIS ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-4320
Practice Address - Country:US
Practice Address - Phone:323-261-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA818473163W00000X
CA95030721363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse