Provider Demographics
NPI:1811228695
Name:MULDAVIN, EUGENE E (LCSW)
Entity Type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:E
Last Name:MULDAVIN
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 1:7392 NW 35TH TER
Mailing Address - Street 2:SUITES 201/202
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1271
Mailing Address - Country:US
Mailing Address - Phone:305-597-9494
Mailing Address - Fax:305-597-9495
Practice Address - Street 1:7392 NW 35TH TER
Practice Address - Street 2:SUITES 201/202
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33122-1271
Practice Address - Country:US
Practice Address - Phone:305-597-9494
Practice Address - Fax:305-597-9495
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW20931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical