Healthcare Provider Details

I. General information

NPI: 1558649004
Provider Name (Legal Business Name): EMILY ELIZABETH EISENMENGER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 QUEEN ST
WORCESTER MA
01610-2473
US

IV. Provider business mailing address

7 INTERVALE RD SECOND FLOOR
WORCESTER MA
01602-2039
US

V. Phone/Fax

Practice location:
  • Phone: 508-860-1000
  • Fax: 508-860-1030
Mailing address:
  • Phone: 508-860-1083
  • Fax: 508-860-1030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberRN2269194
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: