Provider Demographics
NPI:1467771782
Name:EISNER, KELLY ANN (LCPC, LMHC, LPC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:EISNER
Suffix:
Gender:F
Credentials:LCPC, LMHC, LPC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:SOLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:60 FIRE ISLAND AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-3502
Mailing Address - Country:US
Mailing Address - Phone:516-220-5839
Mailing Address - Fax:
Practice Address - Street 1:24W788 75TH ST
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-1684
Practice Address - Country:US
Practice Address - Phone:516-220-5839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005800-1101YM0800X
VA0701004794101YM0800X
IL180014621101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health