Provider Demographics
NPI:1982414512
Name:EISENBERG, MAYA (LPC, ATR-P)
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:EISENBERG
Suffix:
Gender:F
Credentials:LPC, ATR-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9637 STATE ROUTE 534
Mailing Address - Street 2:
Mailing Address - City:MIDDLEFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44062-9516
Mailing Address - Country:US
Mailing Address - Phone:234-699-7531
Mailing Address - Fax:
Practice Address - Street 1:9637 STATE ROUTE 534
Practice Address - Street 2:
Practice Address - City:MIDDLEFIELD
Practice Address - State:OH
Practice Address - Zip Code:44062-9516
Practice Address - Country:US
Practice Address - Phone:234-699-7531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2305103101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor