Provider Demographics
NPI:1811157910
Name:TERRY, ELIZABETH JERISON (PHD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:JERISON
Last Name:TERRY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 MONTANA AVE
Mailing Address - Street 2:# 113
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-1652
Mailing Address - Country:US
Mailing Address - Phone:310-454-3325
Mailing Address - Fax:310-473-2465
Practice Address - Street 1:2211 CORINTH AVE STE 309
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1622
Practice Address - Country:US
Practice Address - Phone:310-454-3325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 20657103TB0200X, 103TC0700X, 103TC2200X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent