Provider Demographics
NPI:1265023402
Name:SAN JUAN JOHNSON, ELORA PATRICE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:ELORA
Middle Name:PATRICE
Last Name:SAN JUAN JOHNSON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:ELORA
Other - Middle Name:PATRICE
Other - Last Name:SAN JUAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8300 ESTERS BLVD STE 900
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-2233
Mailing Address - Country:US
Mailing Address - Phone:415-424-4266
Mailing Address - Fax:415-520-6633
Practice Address - Street 1:10775 PIONEER TRL STE 215
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-0234
Practice Address - Country:US
Practice Address - Phone:415-424-4266
Practice Address - Fax:415-520-6633
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-31
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW223851041C0700X
CA946681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical