Provider Demographics
NPI:1700093465
Name:MAGER, EILEEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:
Last Name:MAGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 CHURCH LN
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3786
Mailing Address - Country:US
Mailing Address - Phone:410-484-1045
Mailing Address - Fax:
Practice Address - Street 1:104 CHURCH LN
Practice Address - Street 2:SUITE 206
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-3786
Practice Address - Country:US
Practice Address - Phone:410-484-1045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1816103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG632Medicare ID - Type Unspecified