Provider Demographics
NPI:1568792430
Name:EISENSTEIN, MITCHEL WAYNE (LMSW, DC)
Entity Type:Individual
Prefix:DR
First Name:MITCHEL
Middle Name:WAYNE
Last Name:EISENSTEIN
Suffix:
Gender:M
Credentials:LMSW, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1727 N OCEAN AVE
Mailing Address - Street 2:CATHOLIC CHARITIES MEDFORD MENTAL HEALTH CLINIC
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-2649
Mailing Address - Country:US
Mailing Address - Phone:631-654-1919
Mailing Address - Fax:
Practice Address - Street 1:1727 N OCEAN AVE
Practice Address - Street 2:CATHOLIC CHARITIES MEDFORD MENTAL HEALTH CLINIC
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-2649
Practice Address - Country:US
Practice Address - Phone:631-654-1919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-28
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078757104100000X
NY007256111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No111N00000XChiropractic ProvidersChiropractor