Basic Information
| Provider Information | |||||||||
| NPI: | 1841310240 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOIADJIEVA | ||||||||
| FirstName: | EUGENIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | L.C.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3702 ALMERIA ST | ||||||||
| Address2: | |||||||||
| City: | SAN PEDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907316412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5622850149 | ||||||||
| FaxNumber: | 5622850156 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 W BROADWAY STE 5010 | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908029409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5622605197 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2007 | ||||||||
| LastUpdateDate: | 02/06/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCS 21744 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.