Healthcare Provider Details

I. General information

NPI: 1396051876
Provider Name (Legal Business Name): ELIZABETH HUESCA MSW, ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2010
Last Update Date: 04/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 WHITTIER BLVD
PICO RIVERA CA
90660-2405
US

IV. Provider business mailing address

9101 WHITTIER BLVD
PICO RIVERA CA
90660-2405
US

V. Phone/Fax

Practice location:
  • Phone: 562-801-4626
  • Fax: 562-801-4630
Mailing address:
  • Phone: 562-801-4626
  • Fax: 562-801-4630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: