Healthcare Provider Details

I. General information

NPI: 1437161312
Provider Name (Legal Business Name): ALEXANDRA M. ELITE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDRA M. ELITE-MARCANDONATOU LCSW

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 WARD ST SUITE 201
BERKELEY CA
94705-1124
US

IV. Provider business mailing address

1635 DIVISADERO ST SUITE 625, BOX 1821
SAN FRANCISCO CA
94143-0001
US

V. Phone/Fax

Practice location:
  • Phone: 415-793-3296
  • Fax:
Mailing address:
  • Phone: 415-476-4029
  • Fax: 415-476-4150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS23210
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: