Provider Demographics
NPI:1598731101
Name:LAMON, EVELYN WILMA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:WILMA
Last Name:LAMON
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:PO BOX 270927
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92198-0927
Mailing Address - Country:US
Mailing Address - Phone:619-993-7508
Mailing Address - Fax:858-679-7510
Practice Address - Street 1:11665 AVENA PLACE
Practice Address - Street 2:SUITE 108
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128
Practice Address - Country:US
Practice Address - Phone:858-668-6454
Practice Address - Fax:858-679-7510
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS78901041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
R37862Medicare UPIN
CASW7890Medicare ID - Type Unspecified