Healthcare Provider Details

I. General information

NPI: 1043731821
Provider Name (Legal Business Name): ELIZABETH CARISA KUNKLE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2017
Last Update Date: 08/10/2025
Certification Date: 08/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31537 RANCHO PUEBLO RD STE 102
TEMECULA CA
92592-4841
US

IV. Provider business mailing address

31537 RANCHO PUEBLO RD STE 102
TEMECULA CA
92592-4841
US

V. Phone/Fax

Practice location:
  • Phone: 833-867-4642
  • Fax: 360-462-2751
Mailing address:
  • Phone: 833-867-4642
  • Fax: 360-462-2751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW129935
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW85502
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: