Provider Demographics
NPI:1225160682
Name:KRAFT, ELIZABETH D (EDD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:D
Last Name:KRAFT
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 W. VICTORIA ST.
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248
Mailing Address - Country:US
Mailing Address - Phone:562-596-8478
Mailing Address - Fax:562-430-6057
Practice Address - Street 1:412 EMERALD PL
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-6223
Practice Address - Country:US
Practice Address - Phone:562-596-8478
Practice Address - Fax:562-430-6057
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 4985103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical