Healthcare Provider Details

I. General information

NPI: 1356329791
Provider Name (Legal Business Name): EVE ELIZABETH LIEVONEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 QUAIL ST SUITE # 240
NEWPORT BEACH CA
92660-2731
US

IV. Provider business mailing address

4 PONDERS END
LAGUNA NIGUEL CA
92677-4129
US

V. Phone/Fax

Practice location:
  • Phone: 949-436-0861
  • Fax: 949-481-8413
Mailing address:
  • Phone: 949-436-0861
  • Fax: 949-481-8413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS15784
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: