Provider Demographics
NPI:1366583726
Name:EDILLOR, CAROLINE ELAYDA
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ELAYDA
Last Name:EDILLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:TOLENTINO
Other - Last Name:ELAYDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:730 BENNETT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-5514
Mailing Address - Country:US
Mailing Address - Phone:707-525-0143
Mailing Address - Fax:707-525-0454
Practice Address - Street 1:730 BENNETT VALLEY RD
Practice Address - Street 2:COUNCIL ON AGING
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-5514
Practice Address - Country:US
Practice Address - Phone:707-525-0143
Practice Address - Fax:707-525-0454
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health