Provider Demographics
NPI:1427565852
Name:MCKEEVER, PAMELA EASTWOOD (LCSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:EASTWOOD
Last Name:MCKEEVER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:L
Other - Last Name:EASTWOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:30802 COAST HWY SPC M3
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-4223
Mailing Address - Country:US
Mailing Address - Phone:714-623-2726
Mailing Address - Fax:
Practice Address - Street 1:30802 COAST HWY SPC M3
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-4223
Practice Address - Country:US
Practice Address - Phone:714-623-2726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW89951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical