Provider Demographics
NPI:1760413710
Name:KINDLE, ELAINE (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:
Last Name:KINDLE
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 S HACIENDA BLVD
Mailing Address - Street 2:SUITE 103-C
Mailing Address - City:HACIENDA HTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-4600
Mailing Address - Country:US
Mailing Address - Phone:626-330-7990
Mailing Address - Fax:626-855-5476
Practice Address - Street 1:2211 S HACIENDA BLVD
Practice Address - Street 2:SUITE 103-C
Practice Address - City:HACIENDA HTS
Practice Address - State:CA
Practice Address - Zip Code:91745-4600
Practice Address - Country:US
Practice Address - Phone:626-330-7990
Practice Address - Fax:626-855-5476
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALL90961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW9096Medicaid
CASW9096Medicare ID - Type UnspecifiedSOCIAL WORKER