Provider Demographics
NPI:1053089706
Name:ELIZABETH KLASKO LCSW LLC
Entity Type:Organization
Organization Name:ELIZABETH KLASKO LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MBR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KLASKO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:610-390-4900
Mailing Address - Street 1:6196 KEY LARGO LANE
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33472
Mailing Address - Country:US
Mailing Address - Phone:610-390-4900
Mailing Address - Fax:866-757-5778
Practice Address - Street 1:6196 KEY LARGO LANE
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33472
Practice Address - Country:US
Practice Address - Phone:610-390-4900
Practice Address - Fax:866-757-5778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty