Provider Demographics
NPI:1043420938
Name:WESTHOLM, EVA MARIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:EVA
Middle Name:MARIA
Last Name:WESTHOLM
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 1:8650 BELFORD AVE APT A210
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-8600
Mailing Address - Country:US
Mailing Address - Phone:310-215-1840
Mailing Address - Fax:
Practice Address - Street 1:15720 VENTURA BLVD STE 600
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2926
Practice Address - Country:US
Practice Address - Phone:818-906-0406
Practice Address - Fax:818-906-1566
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA221641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical