=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659181071
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEANNA MARIE EILENBERGER PSYD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2025
-----------------------------------------------------
Last Update Date | 09/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2005 TECHNOLOGY PKWY STE 400
-----------------------------------------------------
City | MECHANICSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17050-9413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-791-2520
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 KRISTIN DR
-----------------------------------------------------
City | LANDISBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17040-9035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-269-9456
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PS020260
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------