Provider Demographics
NPI:1861183584
Name:BASTONE, ELLA JANE (LCSW)
Entity type:Individual
Prefix:
First Name:ELLA
Middle Name:JANE
Last Name:BASTONE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 CENTRAL AVE APT B
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-3671
Mailing Address - Country:US
Mailing Address - Phone:818-823-5060
Mailing Address - Fax:
Practice Address - Street 1:449 CENTRAL AVE APT B
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-3671
Practice Address - Country:US
Practice Address - Phone:818-823-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1107081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical