Provider Demographics
NPI:1992288609
Name:EISENSTEIN, ROBERT (LICSW)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:EISENSTEIN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 GALLAGHER DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-1407
Mailing Address - Country:US
Mailing Address - Phone:508-927-2068
Mailing Address - Fax:
Practice Address - Street 1:15 GALLAGHER DR
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-1407
Practice Address - Country:US
Practice Address - Phone:508-927-2068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-09
Last Update Date:2018-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10263161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty