Provider Demographics
NPI:1346264264
Name:EISENBERG, BONNIE SHEILA (CLINICAL PSYCHOLOGIS)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:SHEILA
Last Name:EISENBERG
Suffix:
Gender:F
Credentials:CLINICAL PSYCHOLOGIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3514 GLENMOOR DR
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-5638
Mailing Address - Country:US
Mailing Address - Phone:301-652-3730
Mailing Address - Fax:301-652-6658
Practice Address - Street 1:3514 GLENMOOR DR
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-5638
Practice Address - Country:US
Practice Address - Phone:301-652-3730
Practice Address - Fax:301-652-6658
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00998103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD034982Medicare ID - Type Unspecified