Healthcare Provider Details

I. General information

NPI: 1003265786
Provider Name (Legal Business Name): EFRAT EICHENBAUM LP, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W THOMAS RD STE 401
PHOENIX AZ
85013-4423
US

IV. Provider business mailing address

222 W THOMAS RD STE 401
PHOENIX AZ
85013-4423
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-3473
  • Fax: 602-406-4406
Mailing address:
  • Phone: 602-406-3473
  • Fax: 602-406-4406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP5910
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY-005404
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: