Provider Demographics
NPI:1881889996
Name:KLEIN, ELISSA GAIL (ASW)
Entity type:Individual
Prefix:MS
First Name:ELISSA
Middle Name:GAIL
Last Name:KLEIN
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 MARKET ST STE 1277
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-2918
Mailing Address - Country:US
Mailing Address - Phone:415-397-6622
Mailing Address - Fax:415-397-6666
Practice Address - Street 1:870 MARKET ST STE 1277
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-2918
Practice Address - Country:US
Practice Address - Phone:415-397-6622
Practice Address - Fax:415-397-6666
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA201321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical