Provider Demographics
NPI:1851775225
Name:SCHARFFENBERG, ELLEN ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:ANN
Last Name:SCHARFFENBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 JOSIAH CT
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-8814
Mailing Address - Country:US
Mailing Address - Phone:510-685-5697
Mailing Address - Fax:707-514-7180
Practice Address - Street 1:419 ELIZABETH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-4602
Practice Address - Country:US
Practice Address - Phone:510-685-5697
Practice Address - Fax:707-514-7180
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW 646731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA185043Medicare PIN