Provider Demographics
NPI:1851343891
Name:RA, EUNYOUNG (LCSW)
Entity Type:Individual
Prefix:MS
First Name:EUNYOUNG
Middle Name:
Last Name:RA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:EUNICE
Other - Middle Name:
Other - Last Name:RA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:37 JUKBAEK8GIL
Mailing Address - Street 2:117-104
Mailing Address - City:PYEONGTAEK-SI
Mailing Address - State:GYEONGGI-DO
Mailing Address - Zip Code:17860
Mailing Address - Country:KR
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:51ST MEDICAL GROUP
Practice Address - Street 2:UNIT 2060
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96278-2060
Practice Address - Country:US
Practice Address - Phone:505-784-3039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS232891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS23289Medicare ID - Type UnspecifiedCLINICAL SOCIAL WORKER