Provider Demographics
NPI:1588842363
Name:SCHONGOLD, EILEEN SUSAN (LCSW, OTA)
Entity Type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:SUSAN
Last Name:SCHONGOLD
Suffix:
Gender:F
Credentials:LCSW, OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LEO RD
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-1846
Mailing Address - Country:US
Mailing Address - Phone:781-784-0692
Mailing Address - Fax:
Practice Address - Street 1:4 LEO RD
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-1846
Practice Address - Country:US
Practice Address - Phone:781-784-0692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214475104100000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker