Provider Demographics
NPI:1710399670
Name:COLL, ELEANA (LCSW 87111)
Entity Type:Individual
Prefix:
First Name:ELEANA
Middle Name:
Last Name:COLL
Suffix:
Gender:F
Credentials:LCSW 87111
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 INGRAHAM ST APT 226
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-2580
Mailing Address - Country:US
Mailing Address - Phone:415-260-3380
Mailing Address - Fax:
Practice Address - Street 1:741 S ALVARADO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-4021
Practice Address - Country:US
Practice Address - Phone:213-413-6666
Practice Address - Fax:215-351-9504
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA871111041C0700X
CA61196104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker