Provider Demographics
NPI:1740248061
Name:EATON, LINDA FERAR (PHD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:FERAR
Last Name:EATON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 LA JOLLA VILLAGE DRIVE
Mailing Address - Street 2:#500
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122
Mailing Address - Country:US
Mailing Address - Phone:858-546-2990
Mailing Address - Fax:858-535-4890
Practice Address - Street 1:4660 LA JOLLA VILLAGE DRIVE
Practice Address - Street 2:#500
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122
Practice Address - Country:US
Practice Address - Phone:858-546-2990
Practice Address - Fax:858-535-4890
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7075103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP7075AMedicare ID - Type Unspecified