Provider Demographics
NPI:1316346232
Name:ECKSTEIN, MITCHELL (LCSW)
Entity type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:
Last Name:ECKSTEIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:MITCH
Other - Middle Name:
Other - Last Name:ECKSTEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1115 HAWTHORNE DR
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-1976
Mailing Address - Country:US
Mailing Address - Phone:650-458-7920
Mailing Address - Fax:877-991-8755
Practice Address - Street 1:1700 S AMPHLETT BLVD STE 250I
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2728
Practice Address - Country:US
Practice Address - Phone:650-458-7920
Practice Address - Fax:877-991-8755
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-15
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS183811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical