Provider Demographics
NPI:1548770068
Name:EISENBERG, ELIZABETH SARAH
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SARAH
Last Name:EISENBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 NW 1ST AVE APT 403
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-8204
Mailing Address - Country:US
Mailing Address - Phone:305-467-1955
Mailing Address - Fax:
Practice Address - Street 1:347 FLAMINGO DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-7721
Practice Address - Country:US
Practice Address - Phone:914-382-2005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician