1013508670 NPI number — REBECCA FRANCES EISENBERG MSW LICSW

Table of content: REBECCA FRANCES EISENBERG MSW LICSW (NPI 1013508670)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013508670 NPI number — REBECCA FRANCES EISENBERG MSW LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EISENBERG
Provider First Name:
REBECCA
Provider Middle Name:
FRANCES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013508670
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
390 RIVER STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05156-2226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-886-4500
Provider Business Mailing Address Fax Number:
802-886-4560

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
132 S MAIN ST STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITE RIVER JUNCTION
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05001-7234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-295-3031
Provider Business Practice Location Address Fax Number:
802-281-7080
Provider Enumeration Date:
01/27/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  089.0134444 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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