Provider Demographics
NPI:1902676430
Name:YSLA, ELIZABETH JARISIE (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JARISIE
Last Name:YSLA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:JARISIE
Other - Last Name:YSLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2547 GALVESTON ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-2308
Mailing Address - Country:US
Mailing Address - Phone:787-922-1004
Mailing Address - Fax:
Practice Address - Street 1:2547 GALVESTON ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-2308
Practice Address - Country:US
Practice Address - Phone:787-922-1004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1193341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty