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General NPI Number Information
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NPI Number | 1659759892
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Entity Type | Individual
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Provider Name | CHARLES EISENBERG LCSW-R
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Gender | Male
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Dates
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Enumeration Date | 05/07/2015
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Last Update Date | 02/17/2016
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Provider Practice Location Address
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Address Line | 141 BIRCHWOOD RD
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City | CORAM
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State | NY
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Zip | 11727-3675
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Country | US
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Telephone | 212-268-0226
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Fax |
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Provider Business Mailing Address
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Address Line | 3259 44TH ST APT 2L
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City | ASTORIA
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State | NY
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Zip | 11103-2306
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Country | US
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Telephone | 212-268-0226
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 036633
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License Number State | NY
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