Healthcare Provider Details

I. General information

NPI: 1255328803
Provider Name (Legal Business Name): LISA BROWN-EISEL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 NORTH VILLAGE AVENUE SUITE 4
ROCKVILLE CENTRE NY
11570-3767
US

IV. Provider business mailing address

165 NORTH VILLAGE AVENE SUITE 4
ROCKVILLE CENTRE NY
11570-3767
US

V. Phone/Fax

Practice location:
  • Phone: 516-984-1610
  • Fax: 516-764-1717
Mailing address:
  • Phone: 516-984-1610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR051377-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: