Provider Demographics
NPI:1174552160
Name:EATON, ELAINE M (PHD)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:M
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 1:959 E WALNUT ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-1451
Mailing Address - Country:US
Mailing Address - Phone:310-551-7120
Mailing Address - Fax:626-796-7765
Practice Address - Street 1:959 E WALNUT ST
Practice Address - Street 2:SUITE 212
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1451
Practice Address - Country:US
Practice Address - Phone:310-551-7120
Practice Address - Fax:626-796-7765
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5843103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGK513ZOtherMEDICARE PTAN