Provider Demographics
NPI:1629505987
Name:LANDAURO-JOHNSTON, ELISA (BA LAW AND STUDIES)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:LANDAURO-JOHNSTON
Suffix:
Gender:F
Credentials:BA LAW AND STUDIES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SUNNYHILLS DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-1909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 SUNNYHILLS DR
Practice Address - Street 2:
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-1909
Practice Address - Country:US
Practice Address - Phone:415-526-8097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor