Provider Demographics
NPI:1184616674
Name:KEBSCHULL, ELIZABETH ANN (LCSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:KEBSCHULL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 MORGAN LN
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-4751
Mailing Address - Country:US
Mailing Address - Phone:310-938-9854
Mailing Address - Fax:310-944-9190
Practice Address - Street 1:3868 W CARSON ST
Practice Address - Street 2:#220
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-6711
Practice Address - Country:US
Practice Address - Phone:310-938-9854
Practice Address - Fax:310-944-9190
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS206211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS20621OtherSTATE LICENSE #
CASW20621BMedicare ID - Type UnspecifiedMEDICARE PROVIDER #