Provider Demographics
NPI:1669734885
Name:SCRUTCHINS, ELAINA (LCSW)
Entity type:Individual
Prefix:
First Name:ELAINA
Middle Name:
Last Name:SCRUTCHINS
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 1:1303 JEFFERSON ST
Mailing Address - Street 2:SUITE 600A
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-2442
Mailing Address - Country:US
Mailing Address - Phone:707-694-0940
Mailing Address - Fax:707-224-2894
Practice Address - Street 1:1303 JEFFERSON ST
Practice Address - Street 2:600A
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-2442
Practice Address - Country:US
Practice Address - Phone:707-694-0940
Practice Address - Fax:707-224-2894
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA267041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGH591AMedicare PIN