Provider Demographics
NPI:1538950944
Name:BOE, FATINA FATU (LCSW)
Entity type:Individual
Prefix:
First Name:FATINA
Middle Name:FATU
Last Name:BOE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:FATU
Other - Middle Name:TINA
Other - Last Name:BEAKOI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8812 KELBURN AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-5541
Mailing Address - Country:US
Mailing Address - Phone:858-204-5619
Mailing Address - Fax:
Practice Address - Street 1:8812 KELBURN AVE
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-5541
Practice Address - Country:US
Practice Address - Phone:858-204-5619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040183541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty