Provider Demographics
NPI:1477538833
Name:EISENBERG, NANCY LYNN (MSW, LCSW, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:LYNN
Last Name:EISENBERG
Suffix:
Gender:F
Credentials:MSW, LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12345 JONES RD
Mailing Address - Street 2:SUITE, 101
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4855
Mailing Address - Country:US
Mailing Address - Phone:281-890-5334
Mailing Address - Fax:281-894-8611
Practice Address - Street 1:12345 JONES ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4855
Practice Address - Country:US
Practice Address - Phone:281-890-5334
Practice Address - Fax:281-894-8611
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS128431041C0700X
TX001866106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS12843OtherCLINICAL SOCIAL WORKER
TX00S55NMedicare ID - Type Unspecified