Provider Demographics
NPI:1033250568
Name:FUKUMOTO, EVA SHANCHING (LCSW)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:SHANCHING
Last Name:FUKUMOTO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHAN CHING
Other - Middle Name:
Other - Last Name:LEUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:12440 IMPERIAL HWY STE 116
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-8347
Mailing Address - Country:US
Mailing Address - Phone:800-854-7771
Mailing Address - Fax:562-868-4609
Practice Address - Street 1:12440 IMPERIAL HWY STE 116
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-8347
Practice Address - Country:US
Practice Address - Phone:800-854-7771
Practice Address - Fax:562-868-4609
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 254971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical