Provider Demographics
NPI:1730696097
Name:EILBERG, SHERYL GWEN (LICSW)
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:GWEN
Last Name:EILBERG
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1738 COMMONWEALTH AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-5617
Mailing Address - Country:US
Mailing Address - Phone:617-417-0949
Mailing Address - Fax:
Practice Address - Street 1:1738 COMMONWEALTH AVE APT 5
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-5617
Practice Address - Country:US
Practice Address - Phone:617-417-0949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1024881104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker