Provider Demographics
NPI:1003241001
Name:WILLERTON, ELAINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:
Last Name:WILLERTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CLAIRE
Other - Middle Name:ELAINE
Other - Last Name:WILLERTON ACOSTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1080 NIMITZVIEW DR
Mailing Address - Street 2:STE 303
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-4314
Mailing Address - Country:US
Mailing Address - Phone:513-720-5642
Mailing Address - Fax:
Practice Address - Street 1:1080 NIMITZVIEW DR
Practice Address - Street 2:STE 303
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-4314
Practice Address - Country:US
Practice Address - Phone:513-720-5642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-09
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHM1200003106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist