Provider Demographics
NPI:1639594260
Name:EPTING, MARK RICHARD (MSW, LCSW #80432)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:RICHARD
Last Name:EPTING
Suffix:
Gender:M
Credentials:MSW, LCSW #80432
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3019 OCEAN PARK BLVD STE 147
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-3004
Mailing Address - Country:US
Mailing Address - Phone:310-923-8497
Mailing Address - Fax:877-217-2340
Practice Address - Street 1:3231 OCEAN PARK BLVD STE 218
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-3232
Practice Address - Country:US
Practice Address - Phone:310-923-8497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORLCSW122411041C0700X
CALCSW804321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health