Provider Demographics
NPI:1275888539
Name:EISENBERG, LAURIE (PSY D)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:EISENBERG
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 1:369 VAN NESS WAY
Mailing Address - Street 2:#710
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-1489
Mailing Address - Country:US
Mailing Address - Phone:310-787-9334
Mailing Address - Fax:
Practice Address - Street 1:369 VAN NESS WAY
Practice Address - Street 2:#710
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-1489
Practice Address - Country:US
Practice Address - Phone:310-787-9334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PSY 14139103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist