Provider Demographics
NPI:1902573702
Name:RESNICK, ELYSE (LMFT)
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:
Last Name:RESNICK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5405 MOREHOUSE DR STE 330
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-4786
Mailing Address - Country:US
Mailing Address - Phone:650-823-2244
Mailing Address - Fax:
Practice Address - Street 1:5405 MOREHOUSE DR STE 330
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4786
Practice Address - Country:US
Practice Address - Phone:650-823-2244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32425106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist