Provider Demographics
NPI:1437161312
Name:ELITE, ALEXANDRA M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:M
Last Name:ELITE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ALEXANDRA
Other - Middle Name:M
Other - Last Name:ELITE-MARCANDONATOU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1635 DIVISADERO ST
Mailing Address - Street 2:SUITE 625, BOX 1821
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0001
Mailing Address - Country:US
Mailing Address - Phone:415-476-4029
Mailing Address - Fax:415-476-4150
Practice Address - Street 1:2340 WARD ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1124
Practice Address - Country:US
Practice Address - Phone:415-793-3296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS232101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00LCS232100Medicaid
CA00LCS232100Medicaid