Provider Demographics
NPI:1366907669
Name:CREESE, EUGENE ROBERT
Entity type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:ROBERT
Last Name:CREESE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GENO
Other - Middle Name:
Other - Last Name:CREESE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3422 68TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-2122
Mailing Address - Country:US
Mailing Address - Phone:818-919-5180
Mailing Address - Fax:
Practice Address - Street 1:3422 68TH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2122
Practice Address - Country:US
Practice Address - Phone:818-919-5180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-31
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101200000XBehavioral Health & Social Service ProvidersDrama Therapist