Provider Demographics
NPI:1639847361
Name:ONWUCHURUBA, EUGENIA (BCABA)
Entity Type:Individual
Prefix:
First Name:EUGENIA
Middle Name:
Last Name:ONWUCHURUBA
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 ROWAN BLVD APT 611
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-2274
Mailing Address - Country:US
Mailing Address - Phone:856-283-1828
Mailing Address - Fax:
Practice Address - Street 1:629 E WOOD ST STE 204
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-3752
Practice Address - Country:US
Practice Address - Phone:856-308-3139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0-21-12602106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst