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General NPI Number Information
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NPI Number | 1598870438
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Entity Type | Individual
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Provider Name | MARK EISENBERG PH.D.
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Gender | Male
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 251 CAUSEWAY ST ROOM 229
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City | BOSTON
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State | MA
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Zip | 02114-2148
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Country | US
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Telephone | 617-248-1007
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Fax |
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Provider Business Mailing Address
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Address Line | 95 CHASE RUN
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City | STOUGHTON
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State | MA
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Zip | 02072-3558
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Country | US
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Telephone | 781-436-3404
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Fax |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2148
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License Number State | MA
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