Provider Demographics
NPI:1649946005
Name:EINTERZ, LEA ANNE (MSW, LSW)
Entity type:Individual
Prefix:
First Name:LEA
Middle Name:ANNE
Last Name:EINTERZ
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 LAMONTE TER
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46616-1357
Mailing Address - Country:US
Mailing Address - Phone:574-302-2461
Mailing Address - Fax:
Practice Address - Street 1:402 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1526
Practice Address - Country:US
Practice Address - Phone:574-302-2461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33009186A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker