Provider Demographics
NPI:1639322670
Name:KIRKENDALL, ELIZABETH ANN (MSW)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANN
Last Name:KIRKENDALL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:KIRKENDALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:725 LOMITA ST
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-3108
Mailing Address - Country:US
Mailing Address - Phone:310-384-5076
Mailing Address - Fax:310-322-6020
Practice Address - Street 1:725 LOMITA ST
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-3108
Practice Address - Country:US
Practice Address - Phone:310-384-5076
Practice Address - Fax:310-322-6020
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical