Provider Demographics
NPI:1508075219
Name:EISENDRATH, DIANTHE WARREN (MSS)
Entity Type:Individual
Prefix:MRS
First Name:DIANTHE
Middle Name:WARREN
Last Name:EISENDRATH
Suffix:
Gender:F
Credentials:MSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 JUNIPER RD
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-2033
Mailing Address - Country:US
Mailing Address - Phone:617-489-0385
Mailing Address - Fax:617-489-4055
Practice Address - Street 1:85 JUNIPER RD
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-2033
Practice Address - Country:US
Practice Address - Phone:617-489-0385
Practice Address - Fax:617-489-4055
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA100425101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health