MEDICARE: ELAINE BARBARA ELLIS

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
1	1041S0200X	School Social Worker	76302	CA

General Provider Information

NPI Number	:	1972467421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELAINE BARBARA ELLIS

Provider Business Mailing Address
First Line	:	626 BELVEDERE ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94117-4354
Country	:	US
Telephone Number	:	415-506-7738
Fax Number	:

Provider Business Practice Location Address
First Line	:	1575 15TH ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94103-3639
Country	:	US
Telephone Number	:	415-506-7738
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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Directions to “ ELAINE BARBARA ELLIS ” Practice Location

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