Provider Demographics
NPI:1447366026
Name:EICH, JENNIFER FITZGERALD (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:FITZGERALD
Last Name:EICH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:THERESE
Other - Last Name:FITZGERALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:131 W MIDWAY DR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-6507
Mailing Address - Country:US
Mailing Address - Phone:714-517-7107
Mailing Address - Fax:
Practice Address - Street 1:131 W MIDWAY DR
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-6507
Practice Address - Country:US
Practice Address - Phone:714-517-7107
Practice Address - Fax:714-956-1990
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker