| Dr. Elizabeth Wise Licensed Clinical Social Worker Inc. | |
|
2500 Cedarwood Dr. Pine Mountain Club CA 93222 | |
| (310) 422-2047 | |
| Not Available |
| Full Name | Dr. Elizabeth Wise Licensed Clinical Social Worker Inc. |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 2500 Cedarwood Dr., Pine Mountain Club, California |
| Authorized Official Name and Position | Elizabeth Wise (OWNER, PSYCHOTHERAPIST) |
| Authorized Official Contact | 3104222047 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. Elizabeth Wise Licensed Clinical Social Worker Inc. Po Box 6750 Pine Mountain Club CA 93222-6750 Ph: (310) 422-2047 | Dr. Elizabeth Wise Licensed Clinical Social Worker Inc. 2500 Cedarwood Dr. Pine Mountain Club CA 93222 Ph: (310) 422-2047 |
| NPI Number | 1396414744 |
|---|---|
| Provider Enumeration Date | 09/09/2021 |
| Last Update Date | 09/09/2021 |
| Certification Date | 08/24/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396414744 | NPI | - | NPPES |
| 1255833125 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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