Provider Demographics
NPI:1548327646
Name:WAXMAN, ELINOR (MS)
Entity type:Individual
Prefix:MS
First Name:ELINOR
Middle Name:
Last Name:WAXMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 SPRUCE ST.
Mailing Address - Street 2:#3
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709-1461
Mailing Address - Country:US
Mailing Address - Phone:510-548-3294
Mailing Address - Fax:510-548-3294
Practice Address - Street 1:1321 SPRUCE ST
Practice Address - Street 2:#3
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709-1499
Practice Address - Country:US
Practice Address - Phone:510-548-3294
Practice Address - Fax:510-548-3294
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC17160106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist