Provider Demographics
NPI:1043359268
Name:FIDEL, ELAINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:
Last Name:FIDEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S BEVERLY DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4424
Mailing Address - Country:US
Mailing Address - Phone:310-553-5848
Mailing Address - Fax:310-553-5848
Practice Address - Street 1:400 S BEVERLY DR
Practice Address - Street 2:SUITE 103
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4424
Practice Address - Country:US
Practice Address - Phone:310-553-5848
Practice Address - Fax:310-553-5848
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALY0082491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical