Provider Demographics
NPI:1386047496
Name:OWENS, EMILY MADONNA (PHD)
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:MADONNA
Last Name:OWENS
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 1:435 N BEDFORD DR STE 407
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4336
Mailing Address - Country:US
Mailing Address - Phone:310-858-3831
Mailing Address - Fax:
Practice Address - Street 1:435 N BEDFORD DR STE 407
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4336
Practice Address - Country:US
Practice Address - Phone:310-858-3831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31557103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical