Provider Demographics
NPI:1588784839
Name:PURCELL, EILEEN F (LCSW, MSW)
Entity type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:F
Last Name:PURCELL
Suffix:
Gender:F
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27-33 CORSA TER
Mailing Address - Street 2:9B
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3175
Mailing Address - Country:US
Mailing Address - Phone:201-926-0866
Mailing Address - Fax:
Practice Address - Street 1:1156 E RIDGEWOOD AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3935
Practice Address - Country:US
Practice Address - Phone:201-444-4711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC047494001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ44SC04749400OtherLIC. CLINICAL SOCIAL WORK