Healthcare Provider Details

I. General information

NPI: 1942472816
Provider Name (Legal Business Name): MS. JAMIE EISENBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W BELMONT AVE STE 400
CHICAGO IL
60657-3200
US

IV. Provider business mailing address

1300 W BELMONT AVE STE 400
CHICAGO IL
60657-3200
US

V. Phone/Fax

Practice location:
  • Phone: 773-880-1310
  • Fax: 773-880-1321
Mailing address:
  • Phone: 773-880-1310
  • Fax: 773-880-1321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: