Provider Demographics
NPI:1962505834
Name:EILEEN M LEININGER PHD INC
Entity Type:Organization
Organization Name:EILEEN M LEININGER PHD INC
Other - Org Name:EILEEN LEININGER PHD INC
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEININGER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:440-466-7055
Mailing Address - Street 1:794 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:OH
Mailing Address - Zip Code:44041-1943
Mailing Address - Country:US
Mailing Address - Phone:440-466-7055
Mailing Address - Fax:440-466-3455
Practice Address - Street 1:794 S BROADWAY
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:OH
Practice Address - Zip Code:44041-1943
Practice Address - Country:US
Practice Address - Phone:440-466-7055
Practice Address - Fax:440-466-3455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4950103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOH55120Medicaid
OH9326641Medicare PIN