Healthcare Provider Details

I. General information

NPI: 1205773173
Provider Name (Legal Business Name): LISA EUBANK LCSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 DAIRY RD
MELBOURNE FL
32904-5243
US

IV. Provider business mailing address

2590 ARIZONA ST
WEST MELBOURNE FL
32904-6115
US

V. Phone/Fax

Practice location:
  • Phone: 321-960-3859
  • Fax:
Mailing address:
  • Phone: 321-960-3859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LISA ANN EUBANK
Title or Position: OWNER/THERAPIST
Credential: LCSW
Phone: 321-960-3859