Provider Demographics
NPI:1699516492
Name:OZBARDAKCI, ELISE VICTORIA
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:VICTORIA
Last Name:OZBARDAKCI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 CEDAR ST FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1638
Mailing Address - Country:US
Mailing Address - Phone:440-396-8779
Mailing Address - Fax:
Practice Address - Street 1:301 CEDAR ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1638
Practice Address - Country:US
Practice Address - Phone:440-396-8779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent