Provider Demographics
NPI:1164459111
Name:EASTON, MYRIAM POPLAWSKY (MFT)
Entity type:Individual
Prefix:MS
First Name:MYRIAM
Middle Name:POPLAWSKY
Last Name:EASTON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 EAGLE ST
Mailing Address - Street 2:#107
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2974
Mailing Address - Country:US
Mailing Address - Phone:619-517-7618
Mailing Address - Fax:
Practice Address - Street 1:2667 CAMINO DEL RIO S
Practice Address - Street 2:STE # 301-12
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3707
Practice Address - Country:US
Practice Address - Phone:619-517-7618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38848106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist