Provider Demographics
NPI:1194429001
Name:CONLAN, ELIZABETH (LCSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:CONLAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:
Other - Last Name:CONLAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:61 RENATO CT STE 23
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:650-556-4906
Mailing Address - Fax:
Practice Address - Street 1:61 RENATO CT STE 23
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:650-556-4906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW190121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical