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General NPI Number Information
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NPI Number | 1457591679
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Entity Type | Individual
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Provider Name | ELIZABETH ANN EASTLUND LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/27/2009
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Last Update Date | 05/27/2010
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Provider Practice Location Address
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Address Line | 453 W 7TH ST
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City | SAN PEDRO
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State | CA
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Zip | 90731-3207
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Country | US
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Telephone | 310-719-5686
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Fax | 310-548-0611
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Provider Business Mailing Address
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Address Line | 2604 S KERCKHOFF AVE
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City | SAN PEDRO
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State | CA
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Zip | 90731-6518
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Country | US
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Telephone | 310-719-5686
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Fax | 310-519-7795
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS24505
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License Number State | CA
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