Provider Demographics
NPI:1841508884
Name:HAILE, EDEN (LCSW)
Entity type:Individual
Prefix:MISS
First Name:EDEN
Middle Name:
Last Name:HAILE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 FRONT ST STE 490
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1742
Mailing Address - Country:US
Mailing Address - Phone:508-799-2934
Mailing Address - Fax:508-770-1732
Practice Address - Street 1:44 FRONT ST STE 490
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1742
Practice Address - Country:US
Practice Address - Phone:508-799-2934
Practice Address - Fax:508-770-1732
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2157171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical