Provider Demographics
NPI:1164509311
Name:GONZALEZ-JASKULAK, ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:GONZALEZ-JASKULAK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 DRY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-5251
Mailing Address - Country:US
Mailing Address - Phone:310-629-1266
Mailing Address - Fax:831-604-2913
Practice Address - Street 1:261 DRY CREEK RD
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-5251
Practice Address - Country:US
Practice Address - Phone:310-629-1266
Practice Address - Fax:831-604-2913
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS211311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical