Provider Demographics
NPI:1437343332
Name:WRIGHT, EVELYN R (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:R
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:734 SILVER SPUR RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3631
Mailing Address - Country:US
Mailing Address - Phone:310-544-9977
Mailing Address - Fax:310-544-9902
Practice Address - Street 1:734 SILVER SPUR RD
Practice Address - Street 2:SUITE 105
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-3631
Practice Address - Country:US
Practice Address - Phone:310-544-9977
Practice Address - Fax:310-544-9902
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2010-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS20892101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
61-1503486OtherEIN