Provider Demographics
NPI:1396156584
Name:EISENBERG, AMIE MICHELLE (MS LMFT)
Entity type:Individual
Prefix:MS
First Name:AMIE
Middle Name:MICHELLE
Last Name:EISENBERG
Suffix:
Gender:F
Credentials:MS LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13783 NW 20TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2616
Mailing Address - Country:US
Mailing Address - Phone:954-309-3154
Mailing Address - Fax:
Practice Address - Street 1:13783 NW 20TH ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2616
Practice Address - Country:US
Practice Address - Phone:954-309-3154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-11
Last Update Date:2014-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 2890106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist