Provider Demographics
NPI:1598943425
Name:ELAINE, THERESA
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:
Last Name:ELAINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 331
Mailing Address - Street 2:POINT REYES STATION
Mailing Address - City:POINT REYES
Mailing Address - State:CA
Mailing Address - Zip Code:94956
Mailing Address - Country:US
Mailing Address - Phone:415-473-3810
Mailing Address - Fax:
Practice Address - Street 1:100 6TH STREET
Practice Address - Street 2:
Practice Address - City:POINT REYES
Practice Address - State:CA
Practice Address - Zip Code:94956
Practice Address - Country:US
Practice Address - Phone:415-473-3810
Practice Address - Fax:415-473-3828
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical