Healthcare Provider Details

I. General information

NPI: 1881643476
Provider Name (Legal Business Name): DANA EISENBERG L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 CLEVELAND ST
MISSOULA MT
59801-3743
US

IV. Provider business mailing address

528 CLEVELAND ST
MISSOULA MT
59801-3743
US

V. Phone/Fax

Practice location:
  • Phone: 406-549-6800
  • Fax:
Mailing address:
  • Phone: 406-549-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number59867
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number580 LCSW
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: