Provider Demographics
NPI:1184984635
Name:PEW, ELEANOR KAY (MFT)
Entity type:Individual
Prefix:MS
First Name:ELEANOR
Middle Name:KAY
Last Name:PEW
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4155 MOUNTAIN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-4970
Mailing Address - Country:US
Mailing Address - Phone:805-480-0607
Mailing Address - Fax:
Practice Address - Street 1:4155 MOUNTAIN CREEK DR
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-4970
Practice Address - Country:US
Practice Address - Phone:805-480-0607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34542106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist