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NPI Code Detail

MEDICARE: MS. ELAINE DONALD KENDRICK LCSW

MEDICARE: MS. ELAINE DONALD KENDRICK LCSW
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
11041C0700XClinical Social WorkerLCS7391CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1LCS7391OTHERCALCSW

General Provider Information

NPI Number : 1952480410
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ELAINE DONALD KENDRICK LCSW
Provider Business Mailing Address
First Line : 3751 STOCKER ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90008-5101
Country : US
Telephone Number : 323-298-3680
Fax Number : 323-292-0053
Provider Business Practice Location Address
First Line : 3751 STOCKER ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90008-5101
Country : US
Telephone Number : 323-298-3680
Fax Number : 323-292-0053
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2006
Last Update Date : 07/08/2007

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