Provider Demographics
NPI:1982479895
Name:ELZARKA, AYYA (ASW)
Entity type:Individual
Prefix:
First Name:AYYA
Middle Name:
Last Name:ELZARKA
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4727 MOUNTAIRE CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95138-2711
Mailing Address - Country:US
Mailing Address - Phone:408-219-0684
Mailing Address - Fax:
Practice Address - Street 1:206 SACRAMENTO ST # CA204
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2641
Practice Address - Country:US
Practice Address - Phone:408-219-0684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW11992191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical