Provider Demographics
NPI:1518903012
Name:WESTENDORF, ELAINE SUSAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:SUSAN
Last Name:WESTENDORF
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 1:5025 HAMPTON CT
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-6686
Mailing Address - Country:US
Mailing Address - Phone:916-759-6446
Mailing Address - Fax:
Practice Address - Street 1:1899 E ROSEVILLE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-7979
Practice Address - Country:US
Practice Address - Phone:916-759-6446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13106101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health