Provider Demographics
NPI:1255356580
Name:DONAHUE-MARUCHEAU, ELIZABETH
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:DONAHUE-MARUCHEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LIZ
Other - Middle Name:
Other - Last Name:DONAHUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5575 LAKE PARK WAY
Mailing Address - Street 2:#114
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-1664
Mailing Address - Country:US
Mailing Address - Phone:858-467-5454
Mailing Address - Fax:619-463-8986
Practice Address - Street 1:5575 LAKE PARK WAY
Practice Address - Street 2:#114
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-1664
Practice Address - Country:US
Practice Address - Phone:858-467-5454
Practice Address - Fax:619-463-8986
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS147561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical