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NPI Code Detail

MEDICARE: ELIZABETH JEAN ANDERSON

MEDICARE: ELIZABETH JEAN ANDERSON
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
1101Y00000XCounselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1717893OTHERCAMEDICAL

General Provider Information

NPI Number : 1861022956
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH JEAN ANDERSON
Provider Business Mailing Address
First Line : 1909 UNIVERSITY AVE
Second Line :
City : BERKELEY
State : CA
Zip : 94704-1023
Country : US
Telephone Number : 510-809-3004
Fax Number :
Provider Business Practice Location Address
First Line : 1909 UNIVERSITY AVE
Second Line :
City : BERKELEY
State : CA
Zip : 94704-1023
Country : US
Telephone Number : 510-309-3004
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2020
Last Update Date : 01/17/2020

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