Provider Demographics
NPI:1235405408
Name:EIGENBROT, SHIRLEY (LCSW, MAC)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:EIGENBROT
Suffix:
Gender:F
Credentials:LCSW, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 EL CAMINO REAL
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3127
Mailing Address - Country:US
Mailing Address - Phone:650-455-3121
Mailing Address - Fax:650-697-3931
Practice Address - Street 1:1860 EL CAMINO REAL
Practice Address - Street 2:SUITE 310
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3127
Practice Address - Country:US
Practice Address - Phone:650-455-3121
Practice Address - Fax:650-697-3931
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-31
Last Update Date:2012-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS142891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical