Provider Demographics
NPI:1528378890
Name:EISENBERG, LARA B (MA, EDM)
Entity Type:Individual
Prefix:MS
First Name:LARA
Middle Name:B
Last Name:EISENBERG
Suffix:
Gender:F
Credentials:MA, EDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7090 NERI DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-5908
Mailing Address - Country:US
Mailing Address - Phone:914-263-3999
Mailing Address - Fax:914-263-3999
Practice Address - Street 1:9245 ACTIVITY ROAD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126
Practice Address - Country:US
Practice Address - Phone:858-684-3080
Practice Address - Fax:858-684-3181
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor