Provider Demographics
NPI:1497004147
Name:VLADIMIROV, EVGENIYA (LCSW)
Entity Type:Individual
Prefix:
First Name:EVGENIYA
Middle Name:
Last Name:VLADIMIROV
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 LORTON AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-4134
Mailing Address - Country:US
Mailing Address - Phone:415-729-5886
Mailing Address - Fax:
Practice Address - Street 1:345 LORTON AVE STE 104
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4134
Practice Address - Country:US
Practice Address - Phone:415-729-5886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-07
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW849231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical