Provider Demographics
NPI:1376796151
Name:BANADOS, EILEEN ELLSWORTH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:ELLSWORTH
Last Name:BANADOS
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 1:2999 ATLANTIC ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-1005
Mailing Address - Country:US
Mailing Address - Phone:702-241-1249
Mailing Address - Fax:
Practice Address - Street 1:3017 TELEGRAPH AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2049
Practice Address - Country:US
Practice Address - Phone:510-926-6677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-24
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5357-C1041C0700X
CALCSW867401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical