Provider Demographics
NPI:1932283108
Name:WEISS, EUGENIA LIBERMAN
Entity Type:Individual
Prefix:DR
First Name:EUGENIA
Middle Name:LIBERMAN
Last Name:WEISS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EUGENIA
Other - Middle Name:
Other - Last Name:LIBERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD, LCSW
Mailing Address - Street 1:30240 RANCHO VIEJO RD
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1515
Mailing Address - Country:US
Mailing Address - Phone:949-218-8800
Mailing Address - Fax:
Practice Address - Street 1:30240 RANCHO VIEJO RD
Practice Address - Street 2:SUITE C-1
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1515
Practice Address - Country:US
Practice Address - Phone:949-218-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS175991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical