Provider Demographics
NPI:1609364975
Name:MONTEVERDI, ELIZA NIELSEN (MA MFT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZA
Middle Name:NIELSEN
Last Name:MONTEVERDI
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 GREEN MOOR PL
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1164
Mailing Address - Country:US
Mailing Address - Phone:805-807-0317
Mailing Address - Fax:
Practice Address - Street 1:5655 LINDERO CANYON RD STE 401
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-4046
Practice Address - Country:US
Practice Address - Phone:805-807-0317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2021-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102341106H00000X
CA1241965106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA96991262GMedicaid