Provider Demographics
NPI:1366835217
Name:MICHALOPOULOS, EMMA PORTERFIELD (PSYD)
Entity type:Individual
Prefix:DR
First Name:EMMA
Middle Name:PORTERFIELD
Last Name:MICHALOPOULOS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:EMMA
Other - Middle Name:ARLENE
Other - Last Name:PORTERFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:2555 CAMINO DEL RIO S
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3704
Mailing Address - Country:US
Mailing Address - Phone:619-630-4642
Mailing Address - Fax:877-619-0823
Practice Address - Street 1:2555 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 208
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3704
Practice Address - Country:US
Practice Address - Phone:619-630-4642
Practice Address - Fax:877-619-0823
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-16
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29509103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent