Provider Demographics
NPI:1154566313
Name:ELLIOTT, ANN CRISTINA (MSW)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:CRISTINA
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:CRISTINA
Other - Last Name:GOETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2515 OCTAVIA ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-4949
Mailing Address - Country:US
Mailing Address - Phone:510-352-9690
Mailing Address - Fax:
Practice Address - Street 1:15200 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-1013
Practice Address - Country:US
Practice Address - Phone:510-352-9690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA25187OtherASSOCIATE CLINICAL SOCIAL WORK REGISTRATION