Provider Demographics
NPI:1972570216
Name:DELHAGEN, EILEEN (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:DELHAGEN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1926
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-1071
Mailing Address - Country:US
Mailing Address - Phone:732-701-0440
Mailing Address - Fax:
Practice Address - Street 1:2095 ROUTE 88
Practice Address - Street 2:SUITE 3
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3265
Practice Address - Country:US
Practice Address - Phone:732-701-0440
Practice Address - Fax:732-701-0419
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00845400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ051238Medicare PIN