Provider Demographics
NPI:1013077668
Name:KAISER, EUGENIE ELISE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:EUGENIE
Middle Name:ELISE
Last Name:KAISER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 COLLEGE AVE
Mailing Address - Street 2:#2
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2530
Mailing Address - Country:US
Mailing Address - Phone:510-654-8728
Mailing Address - Fax:510-654-8728
Practice Address - Street 1:2311 LOVERIDGE RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-5117
Practice Address - Country:US
Practice Address - Phone:925-431-2637
Practice Address - Fax:925-431-2644
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC30403106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4970Medicaid