Provider Demographics
NPI:1558448126
Name:LEININGER, EILEEN M (PHD)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:M
Last Name:LEININGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:794 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:OH
Mailing Address - Zip Code:44041-1943
Mailing Address - Country:US
Mailing Address - Phone:440-466-7055
Mailing Address - Fax:440-466-3455
Practice Address - Street 1:794 S BROADWAY
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:OH
Practice Address - Zip Code:44041-1943
Practice Address - Country:US
Practice Address - Phone:440-466-7055
Practice Address - Fax:440-466-3455
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4950103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7312147OtherAETNA
OH0155120Medicaid
OH000000282368OtherMAGELLAN
OH000000282368OtherMAGELLAN