Provider Demographics
NPI:1790838852
Name:EILENBERG, SUSAN ANNE (MSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ANNE
Last Name:EILENBERG
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 1:9913 HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-1017
Mailing Address - Country:US
Mailing Address - Phone:314-961-3723
Mailing Address - Fax:314-961-3723
Practice Address - Street 1:8045 BIG BEND BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-2714
Practice Address - Country:US
Practice Address - Phone:314-223-2247
Practice Address - Fax:314-961-3723
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0007531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical