MEDICARE: ELIZABETH J HODGSON 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
1	1041C0700X	Clinical Social Worker	87165	CA

General Provider Information

NPI Number	:	1386109916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH J HODGSON LCSW

Provider Business Mailing Address
First Line	:	1953 KEMPER CIR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90065-1941
Country	:	US
Telephone Number	:	410-718-5666
Fax Number	:

Provider Business Practice Location Address
First Line	:	1953 KEMPER CIR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90065-1941
Country	:	US
Telephone Number	:	410-718-5666
Fax Number	:

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

Provider Enumeration Date	:	02/07/2019
Last Update Date	:	02/07/2019

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