Provider Demographics
NPI:1861918062
Name:SHOSHANA EISENBERGER, LCSW LLC
Entity type:Organization
Organization Name:SHOSHANA EISENBERGER, LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/LCSW
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:SHOSHANA
Authorized Official - Last Name:EISENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:561-206-4638
Mailing Address - Street 1:22345 GUADELOUPE ST
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-4917
Mailing Address - Country:US
Mailing Address - Phone:845-548-3595
Mailing Address - Fax:561-908-6718
Practice Address - Street 1:22345 GUADELOUPE ST
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-4917
Practice Address - Country:US
Practice Address - Phone:845-548-3595
Practice Address - Fax:561-908-6718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-18
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW112721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty