Provider Demographics
NPI:1891055364
Name:NATHANSON, EILEEN L (MFT)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:L
Last Name:NATHANSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:LENA
Other - Middle Name:
Other - Last Name:NATHANSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:3468 MT DIABLO BLVD STE B201
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-3959
Mailing Address - Country:US
Mailing Address - Phone:925-297-5157
Mailing Address - Fax:
Practice Address - Street 1:3468 MT DIABLO BLVD STE B201
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3959
Practice Address - Country:US
Practice Address - Phone:925-297-5157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-18
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist