MEDICARE: SARA EISENBERGER LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	006977	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	006977	OTHER	NY	OFFICE OF THE PROFESSIONS

General Provider Information

NPI Number	:	1215440052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA EISENBERGER LMHC

Provider Business Mailing Address
First Line	:	47 CAUSEWAY
Second Line	:
City	:	LAWRENCE
State	:	NY
Zip	:	11559-1513
Country	:	US
Telephone Number	:	516-400-9788
Fax Number	:

Provider Business Practice Location Address
First Line	:	1311 VIRGINIA ST
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-4630
Country	:	US
Telephone Number	:	718-327-2909
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2017
Last Update Date	:	11/15/2017

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