Provider Demographics
NPI:1407551385
Name:EISENSTADT, SHELLY ELYSE (LCSW)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:ELYSE
Last Name:EISENSTADT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415 KINGS WAY NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-3633
Mailing Address - Country:US
Mailing Address - Phone:404-518-5325
Mailing Address - Fax:
Practice Address - Street 1:4415 KINGS WAY NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-3633
Practice Address - Country:US
Practice Address - Phone:404-518-5325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0049931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical