Provider Demographics
NPI:1417455130
Name:DAIGA, ELEANOR K (LMSW)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:K
Last Name:DAIGA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 RUHAMAH AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205-3211
Mailing Address - Country:US
Mailing Address - Phone:315-399-0869
Mailing Address - Fax:
Practice Address - Street 1:113 RUHAMAH AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-3211
Practice Address - Country:US
Practice Address - Phone:315-399-0869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-28
Last Update Date:2018-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY097613104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker