Provider Demographics
NPI:1659674133
Name:EILERS, BETH E (LCSW)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:E
Last Name:EILERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 CONGRESS ST
Mailing Address - Street 2:ROOM 307
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3566
Mailing Address - Country:US
Mailing Address - Phone:207-874-8784
Mailing Address - Fax:207-874-8913
Practice Address - Street 1:20 PORTLAND ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2912
Practice Address - Country:US
Practice Address - Phone:207-874-8445
Practice Address - Fax:207-874-8975
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC117231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical