Provider Demographics
NPI:1619293362
Name:TOM A. EISENBERG, PH.D.
Entity Type:Organization
Organization Name:TOM A. EISENBERG, PH.D.
Other - Org Name:HUNTINGTON BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:EISENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:626-799-3869
Mailing Address - Street 1:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-0327
Mailing Address - Country:US
Mailing Address - Phone:626-799-3869
Mailing Address - Fax:626-768-7490
Practice Address - Street 1:2130 HUNTINGTON DR
Practice Address - Street 2:#306
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-4964
Practice Address - Country:US
Practice Address - Phone:626-799-3869
Practice Address - Fax:626-768-7490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20136103T00000X
CALCS186941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty