Provider Demographics
NPI:1003265786
Name:EICHENBAUM, EFRAT (LP, PHD)
Entity Type:Individual
Prefix:
First Name:EFRAT
Middle Name:
Last Name:EICHENBAUM
Suffix:
Gender:F
Credentials:LP, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W THOMAS RD STE 401
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4423
Mailing Address - Country:US
Mailing Address - Phone:602-406-3473
Mailing Address - Fax:602-406-4406
Practice Address - Street 1:222 W THOMAS RD STE 401
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4423
Practice Address - Country:US
Practice Address - Phone:602-406-3473
Practice Address - Fax:602-406-4406
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5910103T00000X
AZPSY-005404103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist