Provider Demographics
NPI:1093883803
Name:ECKSTEIN, CHARLES PETER (MA,MFT)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:PETER
Last Name:ECKSTEIN
Suffix:
Gender:M
Credentials:MA,MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 S PACIFIC COAST HWY
Mailing Address - Street 2:STE. 102
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3700
Mailing Address - Country:US
Mailing Address - Phone:310-792-1823
Mailing Address - Fax:310-540-8040
Practice Address - Street 1:423 S PACIFIC COAST HWY
Practice Address - Street 2:STE 102
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3700
Practice Address - Country:US
Practice Address - Phone:310-792-1823
Practice Address - Fax:310-540-8040
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 41510106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist