Provider Demographics
NPI:1972629681
Name:EAGAN, ELENA MARIE (CRC)
Entity type:Individual
Prefix:MRS
First Name:ELENA
Middle Name:MARIE
Last Name:EAGAN
Suffix:
Gender:F
Credentials:CRC
Other - Prefix:
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Mailing Address - Street 1:725 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-3472
Mailing Address - Country:US
Mailing Address - Phone:925-228-0176
Mailing Address - Fax:925-228-0989
Practice Address - Street 1:1420 WILLOW PASS RD
Practice Address - Street 2:SUITE 140
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5223
Practice Address - Country:US
Practice Address - Phone:925-646-5775
Practice Address - Fax:925-646-5680
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA00052292225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor