Provider Demographics
NPI:1992105530
Name:KEANE, ELIZABETH A (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:KEANE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:1500 PALMA DR FL 2
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6451
Mailing Address - Country:US
Mailing Address - Phone:805-263-7048
Mailing Address - Fax:
Practice Address - Street 1:1500 PALMA DR FL 2
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6451
Practice Address - Country:US
Practice Address - Phone:805-263-7048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-02
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA739241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1154954303OtherCONTRACTED 1099-PSYCHOLOGICAL BEHAVIORAL HEALTH INC.
CA1992105530OtherPERSONAL NPI