Provider Demographics
NPI:1528129848
Name:KUDELIN, ELENA (MA, MFT)
Entity type:Individual
Prefix:MS
First Name:ELENA
Middle Name:
Last Name:KUDELIN
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 1:665 LYTTON AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-1335
Mailing Address - Country:US
Mailing Address - Phone:650-266-8212
Mailing Address - Fax:
Practice Address - Street 1:665 LYTTON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-1335
Practice Address - Country:US
Practice Address - Phone:650-266-8212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47182106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist