Provider Demographics
NPI:1508673609
Name:KAIN, ELIZA MARY
Entity type:Individual
Prefix:
First Name:ELIZA
Middle Name:MARY
Last Name:KAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:799 MONTCLAIR DR APT 2
Mailing Address - Street 2:
Mailing Address - City:CLAYMONT
Mailing Address - State:DE
Mailing Address - Zip Code:19703-3678
Mailing Address - Country:US
Mailing Address - Phone:586-850-1964
Mailing Address - Fax:
Practice Address - Street 1:100 W COMMONS BLVD STE 301
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-2419
Practice Address - Country:US
Practice Address - Phone:302-428-0205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ3-0011469104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker