Healthcare Provider Details

I. General information

NPI: 1023679768
Provider Name (Legal Business Name): ELIZABETH SANCHEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W CALIFORNIA BLVD # 1019
PASADENA CA
91105-3005
US

IV. Provider business mailing address

115 W CALIFORNIA BLVD # 1019
PASADENA CA
91105-3005
US

V. Phone/Fax

Practice location:
  • Phone: 312-766-6780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number89281
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number89281
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number118953
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: