1477538833 NPI number — MRS. NANCY LYNN EISENBERG MSW, LCSW, LMFT

Table of content: MRS. NANCY LYNN EISENBERG MSW, LCSW, LMFT (NPI 1477538833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477538833 NPI number — MRS. NANCY LYNN EISENBERG MSW, LCSW, LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EISENBERG
Provider First Name:
NANCY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW, LMFT
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:
1477538833
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12345 JONES RD
Provider Second Line Business Mailing Address:
SUITE, 101
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77070-4855
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-890-5334
Provider Business Mailing Address Fax Number:
281-894-8611

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12345 JONES ROAD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77070-4855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-890-5334
Provider Business Practice Location Address Fax Number:
281-894-8611
Provider Enumeration Date:
12/08/2005

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:  S12843 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 106H00000X , with the licence number: 001866 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: S12843 . This is a "CLINICAL SOCIAL WORKER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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