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General NPI Number Information
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NPI Number | 1093006322
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Entity Type | Individual
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Provider Name | ELEANOR ISADORA OWEN
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Gender | Female
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Dates
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Enumeration Date | 04/20/2011
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Last Update Date | 04/20/2017
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Provider Practice Location Address
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Address Line | 12510 VAN NUYS BLVD STE 201
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City | PACOIMA
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State | CA
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Zip | 91331-6732
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Country | US
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Telephone | 818-896-2266
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Fax | 818-899-7293
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Provider Business Mailing Address
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Address Line | 12510 VAN NUYS BLVD STE 201
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City | PACOIMA
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State | CA
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Zip | 91331-6732
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Country | US
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Telephone | 818-896-2266
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Fax | 818-899-7293
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW73540
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License Number State | CA
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