Healthcare Provider Details

I. General information

NPI: 1396324315
Provider Name (Legal Business Name): ELIZA R DYER LCSW, PPSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471 W LOS ANGELES AVE
SHAFTER CA
93263-2523
US

IV. Provider business mailing address

471 W LOS ANGELES AVE
SHAFTER CA
93263-2523
US

V. Phone/Fax

Practice location:
  • Phone: 661-631-7220
  • Fax:
Mailing address:
  • Phone: 661-631-7220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberLCSW124103
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: