Provider Demographics
NPI:1710200332
Name:APAZA COAQUIRA, EUGENIA TEODOCIA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:EUGENIA
Middle Name:TEODOCIA
Last Name:APAZA COAQUIRA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 E 66TH ST. # B103
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2693
Mailing Address - Country:US
Mailing Address - Phone:952-846-8843
Mailing Address - Fax:
Practice Address - Street 1:1313 E 66TH ST
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2693
Practice Address - Country:US
Practice Address - Phone:952-846-8843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN181301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical