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NPI Code Detail

MEDICARE: ELIZABETH KETCHAM WHITTEKER LCSW

MEDICARE: ELIZABETH KETCHAM WHITTEKER LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerR062296-1NY

General Provider Information

NPI Number : 1174605729
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH KETCHAM WHITTEKER LCSW
Provider Business Mailing Address
First Line : 354 PLAYA BLANCA
Second Line :
City : ENCINITAS
State : CA
Zip : 92024-3648
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3211 JEFFERSON ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92110-4424
Country : US
Telephone Number : 619-682-4012
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2006
Last Update Date : 07/08/2007

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