Provider Demographics
NPI:1649653411
Name:ALBERT, EVA LENORE (LCSW)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:LENORE
Last Name:ALBERT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1750 DELTA WATERS RD STE102 #330
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504
Mailing Address - Country:US
Mailing Address - Phone:541-778-2341
Mailing Address - Fax:541-702-0002
Practice Address - Street 1:2621 WHITTLE AVE STE 6
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-4719
Practice Address - Country:US
Practice Address - Phone:541-778-2341
Practice Address - Fax:541-702-0002
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-29
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL109601041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500700653Medicaid