Provider Demographics
NPI:1730276452
Name:PATE EISENBERG, J. NICOL (LCSW)
Entity type:Individual
Prefix:MS
First Name:J.
Middle Name:NICOL
Last Name:PATE EISENBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:J.
Other - Middle Name:NICOL
Other - Last Name:PATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:PO BOX 56
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80424-0056
Mailing Address - Country:US
Mailing Address - Phone:970-406-8191
Mailing Address - Fax:
Practice Address - Street 1:106 NORTH FRENCH ST.
Practice Address - Street 2:SUITE #210-3
Practice Address - City:BRECKENRIDGE
Practice Address - State:CO
Practice Address - Zip Code:80424
Practice Address - Country:US
Practice Address - Phone:970-406-8191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-052361041C0700X
CO11751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical