Provider Demographics
NPI:1932113297
Name:IVEY, EILEEN GAIL (MSW)
Entity Type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:GAIL
Last Name:IVEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5480 WISCONSIN AVE
Mailing Address - Street 2:SUITE 227
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-3530
Mailing Address - Country:US
Mailing Address - Phone:301-652-1030
Mailing Address - Fax:301-654-1929
Practice Address - Street 1:5480 WISCONSIN AVE
Practice Address - Street 2:SUITE 227
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-3530
Practice Address - Country:US
Practice Address - Phone:301-652-1030
Practice Address - Fax:301-654-1929
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD025401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical