Provider Demographics
NPI:1043434343
Name:AVENI, EILEEN MARIE (MSW)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:MARIE
Last Name:AVENI
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:PO BOX 6007
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48106-6007
Mailing Address - Country:US
Mailing Address - Phone:734-604-0335
Mailing Address - Fax:734-677-1869
Practice Address - Street 1:2311 E STADIUM BLVD STE 212
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4821
Practice Address - Country:US
Practice Address - Phone:734-604-0335
Practice Address - Fax:734-677-1869
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010204951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI80-0-89-6022-0OtherBCBS OF MICHIGAN
MI0N60780Medicare ID - Type UnspecifiedMENTAL HEALTH PROVIDER