Provider Demographics
NPI:1184263691
Name:DEVENS, MARY EILEEN (LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:EILEEN
Last Name:DEVENS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MIMI
Other - Middle Name:
Other - Last Name:DEVENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:17163 SEPTO ST
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-1644
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13701 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2430
Practice Address - Country:US
Practice Address - Phone:818-675-8827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA208221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical