Provider Demographics
NPI:1003006784
Name:EPHRAIM, VERONICA YVETTE (MS)
Entity Type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:YVETTE
Last Name:EPHRAIM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:VERONICA
Other - Middle Name:YVETTE
Other - Last Name:MONTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:1202 MORENA BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3844
Mailing Address - Country:US
Mailing Address - Phone:619-398-3261
Mailing Address - Fax:619-275-2023
Practice Address - Street 1:1202 MORENA BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3844
Practice Address - Country:US
Practice Address - Phone:619-398-3261
Practice Address - Fax:619-275-2023
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 47778106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist