Provider Demographics
NPI:1902870215
Name:ELSHIWICK, ENAS (PSYD,MFT)
Entity type:Individual
Prefix:
First Name:ENAS
Middle Name:
Last Name:ELSHIWICK
Suffix:
Gender:F
Credentials:PSYD,MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6403
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92607-6403
Mailing Address - Country:US
Mailing Address - Phone:949-456-0146
Mailing Address - Fax:
Practice Address - Street 1:2721 E COAST HWY
Practice Address - Street 2:
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625-2131
Practice Address - Country:US
Practice Address - Phone:949-456-0146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20241103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY20241OtherLICENSE