MEDICARE: MS. ELIZABETH KATHERINE WEISENBURGER MS, MA, CRC

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	101Y00000X	Counselor	APCC7817	CA
2	171M00000X	Case Manager/Care Coordinator
3	390200000X	Student in an Organized Health Care Education/Training Program
4	101YM0800X	Mental Health Counselor	APCC7817	CA

General Provider Information

NPI Number	:	1821577081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH KATHERINE WEISENBURGER MS, MA, CRC

Provider Business Mailing Address
First Line	:	1303 W LEWIS ST APT 3
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-1755
Country	:	US
Telephone Number	:	805-403-4289
Fax Number	:

Provider Business Practice Location Address
First Line	:	2103 S EL CAMINO REAL STE 206
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-6281
Country	:	US
Telephone Number	:	442-500-8548
Fax Number	:	760-400-8379

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2018
Last Update Date	:	07/13/2021

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