Provider Demographics
NPI:1285782425
Name:EISENBERG, LINDA (LICSW)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:
Last Name:EISENBERG
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 CAPTAIN EAMES CIR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721-1989
Mailing Address - Country:US
Mailing Address - Phone:508-429-2128
Mailing Address - Fax:508-881-3733
Practice Address - Street 1:23 WATER ST
Practice Address - Street 2:
Practice Address - City:HOLLISTON
Practice Address - State:MA
Practice Address - Zip Code:01746-2364
Practice Address - Country:US
Practice Address - Phone:508-429-2128
Practice Address - Fax:508-881-3733
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA100327101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO1412Medicare ID - Type Unspecified