Provider Demographics
NPI:1003142670
Name:EISEN, ELLEN SCHLOSSBERG (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:SCHLOSSBERG
Last Name:EISEN
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 1:7710 WOLF RIVER CIR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1734
Mailing Address - Country:US
Mailing Address - Phone:901-685-5969
Mailing Address - Fax:901-681-0306
Practice Address - Street 1:7710 WOLF RIVER CIR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1734
Practice Address - Country:US
Practice Address - Phone:901-685-5969
Practice Address - Fax:901-681-0306
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW38261041C0700X
MSC58831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical