Provider Demographics
NPI:1659759892
Name:EISENBERG, CHARLES (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:EISENBERG
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3259 44TH ST
Mailing Address - Street 2:APT 2L
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-2306
Mailing Address - Country:US
Mailing Address - Phone:212-268-0226
Mailing Address - Fax:
Practice Address - Street 1:141 BIRCHWOOD RD
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-3675
Practice Address - Country:US
Practice Address - Phone:212-268-0226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-07
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0366331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical