Provider Demographics
NPI:1518027374
Name:EOVALDI, MISCHA L (LCSW)
Entity Type:Individual
Prefix:
First Name:MISCHA
Middle Name:L
Last Name:EOVALDI
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 1:8065 APTOS ST
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-3904
Mailing Address - Country:US
Mailing Address - Phone:831-685-3219
Mailing Address - Fax:
Practice Address - Street 1:8065 APTOS ST
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-3904
Practice Address - Country:US
Practice Address - Phone:831-685-3219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS187961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical