Provider Demographics
NPI:1770760068
Name:MATHY, EILEEN MARY (LCSW)
Entity type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:MARY
Last Name:MATHY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:MARY
Other - Last Name:UNANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2408 N NOTTINGHAM CT
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-7017
Mailing Address - Country:US
Mailing Address - Phone:217-621-3014
Mailing Address - Fax:
Practice Address - Street 1:306 W GREEN ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-3222
Practice Address - Country:US
Practice Address - Phone:217-621-3014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker