Provider Demographics
NPI:1033218649
Name:AISENBERG, ELEANOR (PSY D)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:
Last Name:AISENBERG
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4136 MADISON ST.
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076
Mailing Address - Country:US
Mailing Address - Phone:312-972-9994
Mailing Address - Fax:
Practice Address - Street 1:10024 SKOKIE BOULEVARD
Practice Address - Street 2:SUITE 312
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077
Practice Address - Country:US
Practice Address - Phone:312-972-9994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-005758103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001625467OtherBLUE CROSS BLUE SHIELD
IL0001625467OtherBLUE CROSS BLUE SHIELD