Provider Demographics
NPI:1619019130
Name:EAGLE, BARBARA M (MSW)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:M
Last Name:EAGLE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 GRANGER AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-4480
Mailing Address - Country:US
Mailing Address - Phone:734-662-0581
Mailing Address - Fax:
Practice Address - Street 1:1945 PAULINE BLVD
Practice Address - Street 2:SUITE 21C
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-5047
Practice Address - Country:US
Practice Address - Phone:734-213-1333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010348671041C0700X
MI4101005763106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008906680OtherBLUE CROSS BLUE SHIELD
MI8008906680OtherBLUE CROSS BLUE SHIELD