MEDICARE: MRS. ELIZABETH JANE KNEGO MSW

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
1	101YM0800X	Mental Health Counselor	LCS11981	CA

General Provider Information

NPI Number	:	1255318358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH JANE KNEGO MSW

Provider Business Mailing Address
First Line	:	4132 KATELLA AVE
Second Line	:	SUITE 206
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-3426
Country	:	US
Telephone Number	:	562-499-2735
Fax Number	:	562-493-4379

Provider Business Practice Location Address
First Line	:	4132 KATELLA AVE
Second Line	:	SUITE 206
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-3426
Country	:	US
Telephone Number	:	562-499-2735
Fax Number	:	562-493-4379

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	07/09/2007

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