Provider Demographics
NPI:1326606633
Name:KAWAJA, ELISABETH (MFT)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:
Last Name:KAWAJA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:KAWAJA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:439 N LARCHMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-3043
Mailing Address - Country:US
Mailing Address - Phone:323-692-3929
Mailing Address - Fax:
Practice Address - Street 1:439 N LARCHMONT BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3043
Practice Address - Country:US
Practice Address - Phone:323-692-3929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-01
Last Update Date:2019-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT37675106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist