Provider Demographics
NPI:1942382015
Name:EICHBERG, CARRIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:
Last Name:EICHBERG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:HORWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:1414 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5023
Mailing Address - Country:US
Mailing Address - Phone:208-343-0570
Mailing Address - Fax:208-429-6682
Practice Address - Street 1:1414 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5023
Practice Address - Country:US
Practice Address - Phone:208-343-0570
Practice Address - Fax:208-429-6682
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY202141103TC0700X
CAPSY17890103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical