Provider Demographics
NPI:1588210652
Name:PEARLMAN, EILEEN MINTZER (PHD)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:MINTZER
Last Name:PEARLMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1137 2ND ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5068
Mailing Address - Country:US
Mailing Address - Phone:310-458-9723
Mailing Address - Fax:
Practice Address - Street 1:1137 2ND ST STE 101
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5068
Practice Address - Country:US
Practice Address - Phone:310-458-9723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CALMFT016532101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty