Provider Demographics
NPI:1134991086
Name:EISENBERG, DANIEL GIDEON GREGORY (MSW, LSW)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:GIDEON GREGORY
Last Name:EISENBERG
Suffix:
Gender:M
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 ONEIDA CT
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-6237
Mailing Address - Country:US
Mailing Address - Phone:917-882-2721
Mailing Address - Fax:
Practice Address - Street 1:950 S CHERRY ST STE 704
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-2665
Practice Address - Country:US
Practice Address - Phone:720-798-4064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLSW.0009924865104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker