Provider Demographics
NPI:1992184311
Name:ELIZALDE-PESCHEK, MARLENE (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:
Last Name:ELIZALDE-PESCHEK
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 1:4354 ARNIE RD
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-9105
Mailing Address - Country:US
Mailing Address - Phone:562-556-1493
Mailing Address - Fax:360-529-4722
Practice Address - Street 1:4354 ARNIE RD
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:WA
Practice Address - Zip Code:98230-9105
Practice Address - Country:US
Practice Address - Phone:562-556-1493
Practice Address - Fax:360-529-4722
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88213106H00000X
CA30285103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist