Provider Demographics
NPI:1730273988
Name:EBERHARDT, DANIEL ROGER (LCSW)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ROGER
Last Name:EBERHARDT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CANTATA DR
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-5102
Mailing Address - Country:US
Mailing Address - Phone:949-874-5960
Mailing Address - Fax:
Practice Address - Street 1:1651 E 4TH ST
Practice Address - Street 2:SUITE 128
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-5164
Practice Address - Country:US
Practice Address - Phone:949-874-5960
Practice Address - Fax:714-972-3744
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS190581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical