Healthcare Provider Details

I. General information

NPI: 1326355769
Provider Name (Legal Business Name): ELIZABETH CYNTHIA LEDEZMA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2010
Last Update Date: 04/06/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1359 N GRAND AVE
COVINA CA
91724-1016
US

IV. Provider business mailing address

1359 N GRAND AVE
COVINA CA
91724-1016
US

V. Phone/Fax

Practice location:
  • Phone: 626-430-2901
  • Fax:
Mailing address:
  • Phone: 626-430-2901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: