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General NPI Number Information
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NPI Number | 1053089706
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Entity Type | Organization
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Legal Business Name | ELIZABETH KLASKO LCSW LLC
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Dates
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Enumeration Date | 08/30/2021
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Last Update Date | 08/30/2021
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Provider Practice Location Address
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Address Line | 6196 KEY LARGO LANE
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City | BOYNTON BEACH
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State | FL
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Zip | 33472
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Country | US
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Telephone | 610-390-4900
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Fax | 866-757-5778
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Provider Business Mailing Address
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Address Line | 6196 KEY LARGO LANE
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City | BOYNTON BEACH
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State | FL
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Zip | 33472
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Country | US
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Telephone | 610-390-4900
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Fax | 866-757-5778
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Authorized Official
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Title or Position | OWNER/MBR
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Name | ELIZABETH KLASKO
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Credential | LCSW
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Telephone | 610-390-4900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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