Provider Demographics
NPI:1912086448
Name:SEMENOV, EDUARD (LMFT)
Entity type:Individual
Prefix:MR
First Name:EDUARD
Middle Name:
Last Name:SEMENOV
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-2464
Mailing Address - Country:US
Mailing Address - Phone:951-715-5050
Mailing Address - Fax:951-784-4986
Practice Address - Street 1:1405 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-2464
Practice Address - Country:US
Practice Address - Phone:951-715-5050
Practice Address - Fax:951-784-4986
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 48423106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist