Healthcare Provider Details

I. General information

NPI: 1639587397
Provider Name (Legal Business Name): ELISA ALVIM-TOLD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2014
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 PERSHING ST STE 1
CRAIG CO
81625-3053
US

IV. Provider business mailing address

2340 W 1620 NORTH CIR
ST GEORGE UT
84770-5313
US

V. Phone/Fax

Practice location:
  • Phone: 917-730-7789
  • Fax: 970-367-1499
Mailing address:
  • Phone: 917-730-7789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9923637
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09923637
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1127
Identifier TypeOTHER
Identifier StateCO
Identifier IssuerNONE
# 2
Identifier52720586
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: