Provider Demographics
NPI:1487220547
Name:EISENBERG, ERICA S (PHD)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:S
Last Name:EISENBERG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 LOCUST ST APT 16EFG
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-3935
Mailing Address - Country:US
Mailing Address - Phone:267-259-3206
Mailing Address - Fax:
Practice Address - Street 1:561 FAIRTHORNE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-2412
Practice Address - Country:US
Practice Address - Phone:267-338-2265
Practice Address - Fax:215-508-2113
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-31
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015027103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical