Provider Demographics
NPI:1619187382
Name:ELDRIDGE, ROBERT PHILLIP (LISW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:PHILLIP
Last Name:ELDRIDGE
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 CHANDLER AVENUE
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140
Mailing Address - Country:US
Mailing Address - Phone:614-446-4644
Mailing Address - Fax:
Practice Address - Street 1:60 CHANDLER AVE
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-1131
Practice Address - Country:US
Practice Address - Phone:614-446-4644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00054531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical