Provider Demographics
NPI:1245376490
Name:SMITH, EILEEN J (LICENSED CLINICAL SO)
Entity type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:LICENSED CLINICAL SO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-8095
Mailing Address - Country:US
Mailing Address - Phone:860-788-6404
Mailing Address - Fax:860-398-6441
Practice Address - Street 1:600 N 2ND ST STE 401
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17101-1071
Practice Address - Country:US
Practice Address - Phone:860-788-6404
Practice Address - Fax:860-398-6441
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PACW0141051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical