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General NPI Number Information
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NPI Number | 1265869200
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Entity Type | Individual
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Provider Name | ELIZABETH EMILY ECCLESTON MSW, ASW
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Gender | Female
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Dates
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Enumeration Date | 10/04/2013
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Last Update Date | 10/04/2013
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Provider Practice Location Address
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Address Line | 901 N PACIFIC COAST HWY SUITE 200A
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City | REDONDO BEACH
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State | CA
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Zip | 90277-2162
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Country | US
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Telephone | 310-316-1610
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Fax |
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Provider Business Mailing Address
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Address Line | 715 S NORMANDIE AVE #520
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City | LOS ANGELES
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State | CA
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Zip | 90005-2267
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Country | US
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Telephone | 312-890-8496
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | ASW 33437
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License Number State | CA
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