Provider Demographics
NPI:1467480962
Name:WEISS, ELAINA CATHERINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELAINA
Middle Name:CATHERINE
Last Name:WEISS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELAINA
Other - Middle Name:
Other - Last Name:WEISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1303 EAST GRAND AVENUE
Mailing Address - Street 2:#215
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420
Mailing Address - Country:US
Mailing Address - Phone:805-441-2768
Mailing Address - Fax:805-473-9100
Practice Address - Street 1:1303 EAST GRAND AVENUE
Practice Address - Street 2:#215
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420
Practice Address - Country:US
Practice Address - Phone:805-441-2768
Practice Address - Fax:805-473-9100
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCF201531041C0700X
CALCS 201531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACSW201530Medicaid
CACSW201530Medicaid