=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720113483
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EVE D. EDEN LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2007
-----------------------------------------------------
Last Update Date | 03/01/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 740 FRONT STREET SUITE 330
-----------------------------------------------------
City | SANTA CRUZ
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-427-8109
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 151 STOCKTON AVENUE
-----------------------------------------------------
City | SANTA CRUZ
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-454-0468
-----------------------------------------------------
Fax | 831-454-0468
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LCSW 11286
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------