Provider Demographics
NPI:1043777410
Name:GERKEN, ELOISE
Entity type:Individual
Prefix:
First Name:ELOISE
Middle Name:
Last Name:GERKEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 EMPIRE ST STE 120
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-5550
Mailing Address - Country:US
Mailing Address - Phone:510-934-5543
Mailing Address - Fax:
Practice Address - Street 1:744 EMPIRE ST STE 120
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5550
Practice Address - Country:US
Practice Address - Phone:707-440-9923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120666106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist