Provider Demographics
NPI:1073730339
Name:EAKINS, SUSAN ELIZABETH ENGEL (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELIZABETH ENGEL
Last Name:EAKINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46173-1198
Mailing Address - Country:US
Mailing Address - Phone:765-932-7591
Mailing Address - Fax:765-932-7576
Practice Address - Street 1:201 CONRAD HARCOURT WAY
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IN
Practice Address - Zip Code:46173-1157
Practice Address - Country:US
Practice Address - Phone:765-932-7591
Practice Address - Fax:765-932-7576
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005682A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN711000001Medicare PIN