Provider Demographics
NPI:1023250172
Name:GRANADOS, ELISA (LCSW)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:GRANADOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELISA
Other - Middle Name:
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:PO BOX 642
Mailing Address - Street 2:
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-0642
Mailing Address - Country:US
Mailing Address - Phone:209-225-9513
Mailing Address - Fax:
Practice Address - Street 1:1604 FORD AVE STE 9
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4655
Practice Address - Country:US
Practice Address - Phone:209-225-9513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CALCSW1264231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program