Provider Demographics
NPI:1629194683
Name:EISDORFER, ALIDA (LMHC)
Entity Type:Individual
Prefix:
First Name:ALIDA
Middle Name:
Last Name:EISDORFER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 EXECUTIVE PARK CT
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-6045
Mailing Address - Country:US
Mailing Address - Phone:407-682-2570
Mailing Address - Fax:407-862-5048
Practice Address - Street 1:660 EXECUTIVE PARK CT
Practice Address - Street 2:SUITE 1000
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-6045
Practice Address - Country:US
Practice Address - Phone:407-682-2570
Practice Address - Fax:407-862-5048
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7840101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7665156 00Medicaid