Provider Demographics
NPI:1295866945
Name:VELISSARATOS-KRATSAS, ELAINE (MS)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:
Last Name:VELISSARATOS-KRATSAS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2617 SILVERADO DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-6420
Mailing Address - Country:US
Mailing Address - Phone:925-522-8366
Mailing Address - Fax:925-522-8366
Practice Address - Street 1:140 MAYHEW WAY
Practice Address - Street 2:606
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4328
Practice Address - Country:US
Practice Address - Phone:925-932-0150
Practice Address - Fax:925-210-0842
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF #44874106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist