MEDICARE: ELIZABETH STROUT A LICENSED CLINICAL SOCIAL WORKER CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1689356818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELIZABETH STROUT A LICENSED CLINICAL SOCIAL WORKER CORPORATION

Provider Business Mailing Address
First Line	:	11230 SORRENTO VALLEY RD STE 220
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1300
Country	:	US
Telephone Number	:	561-315-5914
Fax Number	:

Provider Business Practice Location Address
First Line	:	11230 SORRENTO VALLEY RD STE 220
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1300
Country	:	US
Telephone Number	:	561-315-5914
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ELIZABETH STROUT
Credential	:
Telephone Number	:	561-315-5914

Provider Enumeration Date	:	08/07/2023
Last Update Date	:	12/24/2025

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