MEDICARE: MR. KENNETH EISENBERGER LICSW, DCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LW00005218	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	G8902184	OTHER	WA	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881694321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENNETH EISENBERGER LICSW, DCSW

Provider Business Mailing Address
First Line	:	17183 CLEAR CREEK RD NW
Second Line	:
City	:	POULSBO
State	:	WA
Zip	:	98370-7225
Country	:	US
Telephone Number	:	360-626-1457
Fax Number	:	360-626-1457

Provider Business Practice Location Address
First Line	:	1303 S O ST
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98363-1218
Country	:	US
Telephone Number	:	360-626-1457
Fax Number	:	360-626-1457

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	01/23/2024

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Directions to “ MR. KENNETH EISENBERGER LICSW, DCSW” Practice Location

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