Provider Demographics
NPI:1841310240
Name:BOIADJIEVA, EUGENIE (LCSW)
Entity type:Individual
Prefix:
First Name:EUGENIE
Middle Name:
Last Name:BOIADJIEVA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3702 ALMERIA ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-6412
Mailing Address - Country:US
Mailing Address - Phone:562-285-0149
Mailing Address - Fax:562-285-0156
Practice Address - Street 1:100 W BROADWAY STE 5010
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-9409
Practice Address - Country:US
Practice Address - Phone:562-260-5197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 217441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical