Provider Demographics
NPI:1093006322
Name:OWEN, ELEANOR ISADORA
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:ISADORA
Last Name:OWEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12510 VAN NUYS BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-6732
Mailing Address - Country:US
Mailing Address - Phone:818-896-2266
Mailing Address - Fax:818-899-7293
Practice Address - Street 1:12510 VAN NUYS BLVD STE 201
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-6732
Practice Address - Country:US
Practice Address - Phone:818-896-2266
Practice Address - Fax:818-899-7293
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW735401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical