Provider Demographics
NPI:1003062746
Name:JAIME, EVELINA (LCSW)
Entity Type:Individual
Prefix:
First Name:EVELINA
Middle Name:
Last Name:JAIME
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 EUCLID AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-3610
Mailing Address - Country:US
Mailing Address - Phone:619-266-2111
Mailing Address - Fax:619-266-0496
Practice Address - Street 1:286 EUCLID AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-3610
Practice Address - Country:US
Practice Address - Phone:619-266-2111
Practice Address - Fax:619-266-0496
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS136391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical