Provider Demographics
NPI:1306481213
Name:GROVE, EILEEN NANCY (LCSW)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:NANCY
Last Name:GROVE
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 1:6848 STIRLING RD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-1842
Mailing Address - Country:US
Mailing Address - Phone:954-362-0104
Mailing Address - Fax:954-364-4595
Practice Address - Street 1:6848 STIRLING RD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-1842
Practice Address - Country:US
Practice Address - Phone:954-362-0104
Practice Address - Fax:954-364-4595
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW168151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW16815OtherDEPARTMENT OF HEALTH