Provider Demographics
NPI:1851876585
Name:HATHAWAY, ELLEN DELACEY (LMFT)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:DELACEY
Last Name:HATHAWAY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3702 SACRAMENTO ST STE A
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1740
Mailing Address - Country:US
Mailing Address - Phone:415-702-0277
Mailing Address - Fax:
Practice Address - Street 1:3702 SACRAMENTO ST STE A
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1740
Practice Address - Country:US
Practice Address - Phone:415-702-0277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109641106H00000X
CA119999106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist