Provider Demographics
NPI:1801398680
Name:YAMAMOTO, EUGENE MASAO (LCSW)
Entity Type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:MASAO
Last Name:YAMAMOTO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4088 PORTALS AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-8781
Mailing Address - Country:US
Mailing Address - Phone:559-691-9715
Mailing Address - Fax:
Practice Address - Street 1:5151 N PALM AVE STE 500
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-2271
Practice Address - Country:US
Practice Address - Phone:559-691-9715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA650181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical