Provider Demographics
NPI:1821517400
Name:EISENBERG, JUDITH A (LCSW)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:EISENBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 YORK ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5602
Mailing Address - Country:US
Mailing Address - Phone:203-785-6862
Mailing Address - Fax:203-737-2889
Practice Address - Street 1:98 YORK ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5602
Practice Address - Country:US
Practice Address - Phone:203-785-6862
Practice Address - Fax:203-737-2889
Is Sole Proprietor?:No
Enumeration Date:2017-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0038121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical