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NPI Code Detail

MEDICARE: MR. EDUARDO ABUYOG L.I.C.S.W.

MEDICARE: MR. EDUARDO ABUYOG L.I.C.S.W.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker20793CA
21041C0700XClinical Social WorkerLW00006545WA

General Provider Information

NPI Number : 1912078361
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. EDUARDO ABUYOG L.I.C.S.W.
Provider Business Mailing Address
First Line : 1044 11TH AVE
Second Line :
City : LONGVIEW
State : WA
Zip : 98632-2506
Country : US
Telephone Number : 360-353-9494
Fax Number : 360-353-9440
Provider Business Practice Location Address
First Line : 15455 65TH AVE S
Second Line :
City : TUKWILA
State : WA
Zip : 98188-2534
Country : US
Telephone Number : 206-721-5170
Fax Number : 360-575-1950
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2006
Last Update Date : 04/07/2017

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