Healthcare Provider Details

I. General information

NPI: 1124982947
Provider Name (Legal Business Name): ELIZABETH ADAME
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 E 154TH ST
COMPTON CA
90220-2511
US

IV. Provider business mailing address

401 THE CITY DR S
ORANGE CA
92868-3303
US

V. Phone/Fax

Practice location:
  • Phone: 310-561-5224
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number119696
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: