Provider Demographics
NPI:1669500724
Name:PESKIN, ELLEN (LICENSED MARRIAGE FA)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:
Last Name:PESKIN
Suffix:
Gender:F
Credentials:LICENSED MARRIAGE FA
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:GEISINGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3901 ENOS AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619
Mailing Address - Country:US
Mailing Address - Phone:510-479-7151
Mailing Address - Fax:510-479-7151
Practice Address - Street 1:23 MASONIC AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118
Practice Address - Country:US
Practice Address - Phone:415-922-4525
Practice Address - Fax:510-479-7151
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT12207106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist