Healthcare Provider Details

I. General information

NPI: 1962457655
Provider Name (Legal Business Name): ELIZABETH P GREASON L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 09/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 SIR FRANCIS DRAKE BLVD
KENTFIELD CA
94904-1588
US

IV. Provider business mailing address

15 BROOKSIDE DR
SAN ANSELMO CA
94960-1442
US

V. Phone/Fax

Practice location:
  • Phone: 415-454-2636
  • Fax: 415-454-2636
Mailing address:
  • Phone: 415-454-2636
  • Fax: 415-454-2636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCS18887
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: