Provider Demographics
NPI:1194542654
Name:INTRATOR, ELEANOR D (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:D
Last Name:INTRATOR
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1481 DE PALMA DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-4806
Mailing Address - Country:US
Mailing Address - Phone:408-980-7495
Mailing Address - Fax:
Practice Address - Street 1:1481 DE PALMA DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120-4806
Practice Address - Country:US
Practice Address - Phone:408-980-7495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW13345101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health