Provider Demographics
NPI:1396280467
Name:BOAMAH, EUGENIA
Entity type:Individual
Prefix:
First Name:EUGENIA
Middle Name:
Last Name:BOAMAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 SPRUCE DR STE 2
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-2221
Mailing Address - Country:US
Mailing Address - Phone:908-731-7099
Mailing Address - Fax:
Practice Address - Street 1:1139 SPRUCE DR STE 2
Practice Address - Street 2:
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092-2221
Practice Address - Country:US
Practice Address - Phone:908-731-7099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-28
Last Update Date:2024-10-07
Deactivation Date:2018-03-02
Deactivation Code:
Reactivation Date:2021-03-31
Provider Licenses
StateLicense IDTaxonomies
NJ44SC058245001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical