Provider Demographics
NPI:1992041768
Name:BUENROSTRO, ELSA QUINTANA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELSA
Middle Name:QUINTANA
Last Name:BUENROSTRO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:ELSA
Other - Middle Name:QUINTANA
Other - Last Name:MAGANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2050 S BLOSSER RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-7310
Mailing Address - Country:US
Mailing Address - Phone:805-361-8030
Mailing Address - Fax:805-361-8097
Practice Address - Street 1:430 S BLOSSER RD
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-4908
Practice Address - Country:US
Practice Address - Phone:805-361-8030
Practice Address - Fax:805-361-8097
Is Sole Proprietor?:No
Enumeration Date:2012-12-21
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA831371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health