Provider Demographics
NPI:1962457655
Name:GREASON, ELIZABETH P (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:P
Last Name:GREASON
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 1:15 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-1442
Mailing Address - Country:US
Mailing Address - Phone:415-454-2636
Mailing Address - Fax:415-454-2636
Practice Address - Street 1:905 SIR FRANCIS DRAKE BLVD
Practice Address - Street 2:
Practice Address - City:KENTFIELD
Practice Address - State:CA
Practice Address - Zip Code:94904-1588
Practice Address - Country:US
Practice Address - Phone:415-454-2636
Practice Address - Fax:415-454-2636
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS18887101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADA236AMedicare PIN