Provider Demographics
NPI:1730618216
Name:DUMESNIL, ELISA (MFT)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:DUMESNIL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 LEIMERT BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-1852
Mailing Address - Country:US
Mailing Address - Phone:510-338-4233
Mailing Address - Fax:
Practice Address - Street 1:1425 LEIMERT BLVD STE 202
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-1852
Practice Address - Country:US
Practice Address - Phone:510-338-4233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC44766106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist