Basic Information
Provider Information
NPI: 1770611543
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BELL
FirstName: ELENA
MiddleName: FRANCES
NamePrefix: MS.
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4760 SEPULVEDA BLVD
Address2:  
City: CULVER CITY
State: CA
PostalCode: 902304820
CountryCode: US
TelephoneNumber: 3103906612
FaxNumber: 3103985690
Practice Location
Address1: 12420 VENICE BLVD STE 200
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900663841
CountryCode: US
TelephoneNumber: 3107511200
FaxNumber: 3103980312
Other Information
ProviderEnumerationDate: 03/01/2007
LastUpdateDate: 07/15/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700XLCS20633CAY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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