Provider Demographics
NPI:1962591321
Name:EISENBERG, KAREN SUE (LCSW)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:SUE
Last Name:EISENBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 KENWOOD CT
Mailing Address - Street 2:
Mailing Address - City:NORTH CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-4138
Mailing Address - Country:US
Mailing Address - Phone:973-226-7493
Mailing Address - Fax:
Practice Address - Street 1:60 S FULLERTON AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2632
Practice Address - Country:US
Practice Address - Phone:973-744-6522
Practice Address - Fax:973-744-6362
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ055002Medicare ID - Type UnspecifiedMEDICARE I.D. NUMBER