Healthcare Provider Details

I. General information

NPI: 1528263704
Provider Name (Legal Business Name): ELIZABETH D. PEZOA LCSW, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH D. PEZOA LCSW, LPCC

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 W B ST FL 4
SAN DIEGO CA
92101-3537
US

IV. Provider business mailing address

550 W B ST FL 4
SAN DIEGO CA
92101-3537
US

V. Phone/Fax

Practice location:
  • Phone: 845-702-9167
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC817
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW22323
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: