Provider Demographics
NPI:1265869200
Name:ECCLESTON, ELIZABETH EMILY (MSW, ASW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:EMILY
Last Name:ECCLESTON
Suffix:
Gender:F
Credentials:MSW, ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 S NORMANDIE AVE
Mailing Address - Street 2:#520
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-2267
Mailing Address - Country:US
Mailing Address - Phone:312-890-8496
Mailing Address - Fax:
Practice Address - Street 1:901 N PACIFIC COAST HWY
Practice Address - Street 2:SUITE 200A
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-2162
Practice Address - Country:US
Practice Address - Phone:310-316-1610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 33437104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker