Provider Demographics
NPI:1508222332
Name:ELIAS, ELIVERTO I (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ELIVERTO
Middle Name:
Last Name:ELIAS
Suffix:I
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:ELI
Other - Middle Name:
Other - Last Name:ELIAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 384
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:CA
Mailing Address - Zip Code:93227-0384
Mailing Address - Country:US
Mailing Address - Phone:559-545-3476
Mailing Address - Fax:
Practice Address - Street 1:4001 KING AVE
Practice Address - Street 2:
Practice Address - City:CORCORAN
Practice Address - State:CA
Practice Address - Zip Code:93212-9611
Practice Address - Country:US
Practice Address - Phone:559-992-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-08
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA926651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical