Provider Demographics
NPI:1255318358
Name:KNEGO, ELIZABETH JANE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:JANE
Last Name:KNEGO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4132 KATELLA AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3426
Mailing Address - Country:US
Mailing Address - Phone:562-499-2735
Mailing Address - Fax:562-493-4379
Practice Address - Street 1:4132 KATELLA AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3426
Practice Address - Country:US
Practice Address - Phone:562-499-2735
Practice Address - Fax:562-493-4379
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS11981101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW11981Medicare UPIN