Provider Demographics
NPI:1457369506
Name:GINZBURG, EVELINE (MFT)
Entity Type:Individual
Prefix:
First Name:EVELINE
Middle Name:
Last Name:GINZBURG
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 1:152 S LASKY DR STE 101
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-1715
Mailing Address - Country:US
Mailing Address - Phone:310-364-1661
Mailing Address - Fax:310-836-4449
Practice Address - Street 1:152 S LASKY DR STE 101
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1715
Practice Address - Country:US
Practice Address - Phone:310-364-1661
Practice Address - Fax:310-836-4449
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6735106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist