Provider Demographics
NPI:1033317342
Name:ARNOLD, EUGENIE (MFT)
Entity Type:Individual
Prefix:
First Name:EUGENIE
Middle Name:
Last Name:ARNOLD
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 1:111 FAIRLAWN DR
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94708-2107
Mailing Address - Country:US
Mailing Address - Phone:510-549-0510
Mailing Address - Fax:925-828-8238
Practice Address - Street 1:350 BERKELEY PARK BLVD
Practice Address - Street 2:SUITE #3
Practice Address - City:KENSINGTON
Practice Address - State:CA
Practice Address - Zip Code:94707-1248
Practice Address - Country:US
Practice Address - Phone:510-549-0510
Practice Address - Fax:925-828-8238
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 16150106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA771Medicaid