Provider Demographics
NPI:1598117590
Name:ECKMAN, DENISE MARIE (PSYD, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:MARIE
Last Name:ECKMAN
Suffix:
Gender:F
Credentials:PSYD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 DOW AVE
Mailing Address - Street 2:#122
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-7233
Mailing Address - Country:US
Mailing Address - Phone:949-328-7688
Mailing Address - Fax:949-328-7689
Practice Address - Street 1:3002 DOW AVE
Practice Address - Street 2:#122
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7233
Practice Address - Country:US
Practice Address - Phone:949-328-7688
Practice Address - Fax:949-328-7689
Is Sole Proprietor?:No
Enumeration Date:2016-07-01
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29256103T00000X
CA1-07-3777103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103T00000XBehavioral Health & Social Service ProvidersPsychologist