Provider Demographics
NPI:1568640431
Name:MILLER, ELYSE (LCSW)
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:
Last Name:MILLER
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 1:101 GROVE ST RM 323
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-4505
Mailing Address - Country:US
Mailing Address - Phone:415-554-2647
Mailing Address - Fax:415-554-2658
Practice Address - Street 1:101 GROVE ST RM 323
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-4505
Practice Address - Country:US
Practice Address - Phone:415-554-2647
Practice Address - Fax:415-554-2658
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 206711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical