Provider Demographics
NPI:1710998588
Name:STEIN, EILEEN F (LCSW)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:F
Last Name:STEIN
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 1:199 SCOLES AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1125
Mailing Address - Country:US
Mailing Address - Phone:973-777-7638
Mailing Address - Fax:973-777-9311
Practice Address - Street 1:199 SCOLES AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1125
Practice Address - Country:US
Practice Address - Phone:973-777-7638
Practice Address - Fax:973-777-9311
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051693001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ253835OtherMHN ID
NJ0021784Medicaid
NJ7200534OtherAETNA ID
NJ7409251OtherGHI ID
NJ508907OtherVALUE OPTION ID
NJP-2951883OtherOXFORD ID
NJ7200534OtherAETNA ID