Provider Demographics
NPI:1427249044
Name:BLINE, EILEEN F (LISW-S)
Entity type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:F
Last Name:BLINE
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 OFFICENTER PL STE 160
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-5351
Mailing Address - Country:US
Mailing Address - Phone:614-664-3595
Mailing Address - Fax:614-664-3595
Practice Address - Street 1:195 UNION ST STE B1
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-3998
Practice Address - Country:US
Practice Address - Phone:740-349-7066
Practice Address - Fax:740-345-6028
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00089471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH10193Medicaid
OH31-0711374OtherTAX ID#
OH1376607374OtherORGANIZATION NPI#
OH31-0711374OtherTAX ID#