Provider Demographics
NPI:1932223450
Name:CANCRO, ELENA (PSYD)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:CANCRO
Suffix:
Gender:F
Credentials:PSYD
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 33
Mailing Address - Street 2:
Mailing Address - City:SOULSBYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95372-0033
Mailing Address - Country:US
Mailing Address - Phone:209-533-8230
Mailing Address - Fax:
Practice Address - Street 1:19410 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-9228
Practice Address - Country:US
Practice Address - Phone:209-533-8230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC25380106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist