MEDICARE: MRS. GERALDINE ELIZABETH ELLIOTT LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	1232	KY

General Provider Information

NPI Number	:	1942231725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GERALDINE ELIZABETH ELLIOTT LCSW

Provider Business Mailing Address
First Line	:	2521 ANDERSON ROAD
Second Line	:	SUITE A
City	:	CRESENT SPRINGS
State	:	KY
Zip	:	41017-5121
Country	:	US
Telephone Number	:	859-344-9321
Fax Number	:	859-344-0731

Provider Business Practice Location Address
First Line	:	2521 ANDERSON ROAD
Second Line	:	SUITE A
City	:	CRESENT SPRINGS
State	:	KY
Zip	:	41017-5121
Country	:	US
Telephone Number	:	859-344-9321
Fax Number	:	859-344-0731

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	07/15/2014

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