Individual
ELIZABETH BACON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
3020 CHILDRENS WAY # MC5042, SAN DIEGO, CA 92123-4223
(858) 966-7453
Mailing address
3020 CHILDRENS WAY # MC5042, SAN DIEGO, CA 92123-4223
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
29317
CA
Other
Enumeration date
10/05/2018
Last updated
10/05/2018
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