Healthcare Provider Details

I. General information

NPI: 1689438558
Provider Name (Legal Business Name): ELIZABETH M HUCK ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 W VALENCIA DR # 387
FULLERTON CA
92833-4034
US

IV. Provider business mailing address

1303 W VALENCIA DR # 387
FULLERTON CA
92833-4034
US

V. Phone/Fax

Practice location:
  • Phone: 714-726-2441
  • Fax:
Mailing address:
  • Phone: 714-726-2441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW141963
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: