Healthcare Provider Details

I. General information

NPI: 1114059078
Provider Name (Legal Business Name): ELIZABETH GALLEGO MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH M. GALLEGO ASW33532

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 EAST COLORADO BLVD., SUITE #100
PASADENA CA
91107-6622
US

IV. Provider business mailing address

2650 E FOOTHILL BLVD
PASADENA CA
91107-3439
US

V. Phone/Fax

Practice location:
  • Phone: 626-577-2261
  • Fax: 626-577-2543
Mailing address:
  • Phone: 626-577-2261
  • Fax: 626-577-2543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW33532
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW82584
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: