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General NPI Number Information
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NPI Number | 1356539019
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Entity Type | Individual
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Provider Name | ELLEN STARBIRD L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 10/22/2012
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Provider Practice Location Address
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Address Line | 2040 VINE ST
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City | BERKELEY
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State | CA
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Zip | 94709-2034
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Country | US
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Telephone | 510-520-3314
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9541
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City | BERKELEY
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State | CA
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Zip | 94709-0541
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Country | US
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Telephone | 510-520-3314
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 22799
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License Number State | CA
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