Provider Demographics
NPI:1255499224
Name:EATON, ALICE (EDD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:
Last Name:EATON
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 HIDDEN SPRING LN
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-2327
Mailing Address - Country:US
Mailing Address - Phone:215-968-6062
Mailing Address - Fax:
Practice Address - Street 1:121 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-2424
Practice Address - Country:US
Practice Address - Phone:856-642-6472
Practice Address - Fax:856-642-6435
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJS101329103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJEA016771Medicare UPIN