Provider Demographics
NPI:1417294554
Name:EISNER PSYCHOLOGICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:EISNER PSYCHOLOGICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:EISNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:818-788-6512
Mailing Address - Street 1:16133 VENTURA BLVD
Mailing Address - Street 2:NO, 700
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2403
Mailing Address - Country:US
Mailing Address - Phone:818-788-6512
Mailing Address - Fax:818-788-1847
Practice Address - Street 1:16133 VENTURA BLVD
Practice Address - Street 2:NO, 700
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2403
Practice Address - Country:US
Practice Address - Phone:818-788-6512
Practice Address - Fax:818-788-1847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5920103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty