Provider Demographics
NPI:1033234547
Name:EISENBERG, SUSAN (ACSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:EISENBERG
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:HERMAN
Other - Last Name:EISENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACSW
Mailing Address - Street 1:14 SMULL AVENUE
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-5012
Mailing Address - Country:US
Mailing Address - Phone:973-228-9177
Mailing Address - Fax:973-228-9177
Practice Address - Street 1:14 SMULL AVENUE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-5012
Practice Address - Country:US
Practice Address - Phone:973-228-9177
Practice Address - Fax:973-228-9177
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC008369001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical