Provider Demographics
NPI:1942231725
Name:ELLIOTT, GERALDINE ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GERALDINE
Middle Name:ELIZABETH
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:GERALDINE
Other - Middle Name:ROBERTS
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2521 ANDERSON ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CRESENT SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-5121
Mailing Address - Country:US
Mailing Address - Phone:859-344-9321
Mailing Address - Fax:859-344-0731
Practice Address - Street 1:2521 ANDERSON ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:CRESENT SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:41017-5121
Practice Address - Country:US
Practice Address - Phone:859-344-9321
Practice Address - Fax:859-344-0731
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY12321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCSW0295Medicare ID - Type Unspecified
088677000OtherANTHEM