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NPI Code Detail

MEDICARE: ELIZABETH WIELAND ACSW 72261

MEDICARE:   ELIZABETH  WIELAND  ACSW 72261
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
1104100000XSocial Worker

General Provider Information

NPI Number : 1942652805
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH WIELAND ACSW 72261
Provider Business Mailing Address
First Line : 4163 VIA MARINA APT 209
Second Line :
City : MARINA DEL REY
State : CA
Zip : 90292-5328
Country : US
Telephone Number : 224-392-4087
Fax Number :
Provider Business Practice Location Address
First Line : 1125 W 6TH ST STE 103
Second Line :
City : LOS ANGELES
State : CA
Zip : 90017-1896
Country : US
Telephone Number : 213-202-3970
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/04/2016
Last Update Date : 10/14/2019

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