Provider Demographics
NPI:1841620770
Name:EROS, ELISABETH (MA, MFT)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:
Last Name:EROS
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 RENATO CT STE 22
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-4016
Mailing Address - Country:US
Mailing Address - Phone:650-400-5399
Mailing Address - Fax:
Practice Address - Street 1:61 RENATO CT STE 22
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-4016
Practice Address - Country:US
Practice Address - Phone:650-400-5399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC53813106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist