Provider Demographics
NPI:1609149004
Name:DUBE, ELIZABETH WALKER (MA, MS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:WALKER
Last Name:DUBE
Suffix:
Gender:F
Credentials:MA, MS
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:MARIE
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, MS
Mailing Address - Street 1:2410 SAN ANSELINE AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-2043
Mailing Address - Country:US
Mailing Address - Phone:562-277-1069
Mailing Address - Fax:
Practice Address - Street 1:4000 MACARTHUR BLVD STE 900
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2522
Practice Address - Country:US
Practice Address - Phone:800-769-0342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 66092106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist