Provider Demographics
NPI:1669653374
Name:EISAEIAN, MEG (LCSW)
Entity Type:Individual
Prefix:
First Name:MEG
Middle Name:
Last Name:EISAEIAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MEGHEDI
Other - Middle Name:
Other - Last Name:EISAEIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6957 N FIGUEROA ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-1245
Mailing Address - Country:US
Mailing Address - Phone:323-443-3143
Mailing Address - Fax:323-443-3265
Practice Address - Street 1:6957 N FIGUEROA ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-1245
Practice Address - Country:US
Practice Address - Phone:323-443-3143
Practice Address - Fax:323-443-3265
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-21
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA670131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical