Provider Demographics
NPI:1740528793
Name:EISENBERG, DAVID MICHAEL (LCSW)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:EISENBERG
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 S OCTORARA TRL
Mailing Address - Street 2:
Mailing Address - City:PARKESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:19365-2100
Mailing Address - Country:US
Mailing Address - Phone:717-560-3782
Mailing Address - Fax:
Practice Address - Street 1:950 S OCTORARA TRL
Practice Address - Street 2:
Practice Address - City:PARKESBURG
Practice Address - State:PA
Practice Address - Zip Code:19365-2100
Practice Address - Country:US
Practice Address - Phone:717-560-3782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-26
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0187531041C0700X
CA660431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical