Provider Demographics
NPI:1760465751
Name:STEIN, EILEEN RACHEL (MSSW, LICSW)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:RACHEL
Last Name:STEIN
Suffix:
Gender:F
Credentials:MSSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 CUTTING HORSE CT
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76087-6629
Mailing Address - Country:US
Mailing Address - Phone:206-948-2181
Mailing Address - Fax:
Practice Address - Street 1:108 CUTTING HORSE CT
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76087-6629
Practice Address - Country:US
Practice Address - Phone:206-948-2181
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000044111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8800077Medicare ID - Type Unspecified