Provider Demographics
NPI:1801924758
Name:STRIVERSON, ELLEN LORETTA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:LORETTA
Last Name:STRIVERSON
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 1:1086 W CALLE DE LAS ESTRELLAS
Mailing Address - Street 2:APT. 2
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-1722
Mailing Address - Country:US
Mailing Address - Phone:626-354-5420
Mailing Address - Fax:
Practice Address - Street 1:1245 E WALNUT ST
Practice Address - Street 2:SUITE 117
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1878
Practice Address - Country:US
Practice Address - Phone:626-795-9127
Practice Address - Fax:626-795-0979
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA671851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical