Provider Demographics
NPI:1932585007
Name:EUFRACIO, MARTHA (MSW, ASW)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:
Last Name:EUFRACIO
Suffix:
Gender:F
Credentials:MSW, ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6680 AVENIDA MICHAELINDA
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92509-7227
Mailing Address - Country:US
Mailing Address - Phone:909-620-8088
Mailing Address - Fax:
Practice Address - Street 1:1555 S GAREY AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-5222
Practice Address - Country:US
Practice Address - Phone:909-620-8088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW660121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical