Provider Demographics
NPI:1174742480
Name:GADOMSKI, ELIZABETH (PSYD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:GADOMSKI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:GADOMSKI
Other - Last Name:KRIMSTOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:4001 HOWE ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5211
Mailing Address - Country:US
Mailing Address - Phone:917-568-1564
Mailing Address - Fax:
Practice Address - Street 1:4001 HOWE ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5211
Practice Address - Country:US
Practice Address - Phone:415-890-3995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
9562OtherSFGH INTERNAL USE ONLY
9562OtherCBHS INTERNAL USE ONLY-COMMERCIAL NUMBER
CA390200000XOtherSTUDENT, HEALTH CARE