Provider Demographics
NPI:1558603399
Name:EISENBERGER, STEPHANIE SHOSHANA (LCSW, CLC)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:SHOSHANA
Last Name:EISENBERGER
Suffix:
Gender:F
Credentials:LCSW, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22345 GUADELOUPE ST
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-4917
Mailing Address - Country:US
Mailing Address - Phone:845-548-4535
Mailing Address - Fax:
Practice Address - Street 1:22345 GUADELOUPE ST
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-4917
Practice Address - Country:US
Practice Address - Phone:845-548-4535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW112721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical