Provider Demographics
NPI:1750941597
Name:EATON, GINA N (CDCA QMHSMA CMSMA)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:N
Last Name:EATON
Suffix:
Gender:F
Credentials:CDCA QMHSMA CMSMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3224 E 123RD ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-3850
Mailing Address - Country:US
Mailing Address - Phone:216-990-2143
Mailing Address - Fax:
Practice Address - Street 1:3224 E 123RD ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-3850
Practice Address - Country:US
Practice Address - Phone:216-990-2143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-14
Last Update Date:2024-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251X00000X, 332U00000X, 347C00000X, 174400000X, 372600000X, 374K00000X, 376J00000X, 385HR2060X, 172V00000X
OHCDCA170113101Y00000X
OH171M00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No251X00000XAgenciesSupports Brokerage
No332U00000XSuppliersHome Delivered Meals
No347C00000XTransportation ServicesPrivate Vehicle
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174400000XOther Service ProvidersSpecialist
No251S00000XAgenciesCommunity/Behavioral Health
No372600000XNursing Service Related ProvidersAdult Companion
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
No376J00000XNursing Service Related ProvidersHomemaker
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child