Healthcare Provider Details

I. General information

NPI: 1295899938
Provider Name (Legal Business Name): ELIZABETH ELDER L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18600 MAIN ST STE 295
HUNTINGTON BEACH CA
92648-1728
US

IV. Provider business mailing address

323 CANAL WAY
COSTA MESA CA
92627-2292
US

V. Phone/Fax

Practice location:
  • Phone: 714-878-9796
  • Fax:
Mailing address:
  • Phone: 714-878-9726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22898
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: