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General NPI Number Information
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NPI Number | 1093187288
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Entity Type | Individual
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Provider Name | JOHN D EICHENBERGER L.M.H.C., C.A.S.A.C.
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Gender | Male
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Dates
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Enumeration Date | 10/27/2015
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Last Update Date | 10/27/2015
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Provider Practice Location Address
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Address Line | 625 CROSS KEYS OFFICE PARK BUILDING 600 SUITE 625
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City | FAIRPORT
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State | NY
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Zip | 14450-3508
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Country | US
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Telephone | 585-425-2840
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Fax | 585-425-2196
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Provider Business Mailing Address
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Address Line | 625 CROSS KEYS OFFICE PARK BUILDING 600 SUITE 625
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City | FAIRPORT
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State | NY
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Zip | 14450-3508
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Country | US
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Telephone | 585-425-2840
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Fax | 585-425-2196
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 17971
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 006328
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License Number State | NY
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