Provider Demographics
NPI:1205883550
Name:EISENBEIS, CYNTHIA MARIE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:MARIE
Last Name:EISENBEIS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 BULL VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63304-8544
Mailing Address - Country:US
Mailing Address - Phone:314-484-6198
Mailing Address - Fax:
Practice Address - Street 1:223 N MAIN ST
Practice Address - Street 2:SUITE #3
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2828
Practice Address - Country:US
Practice Address - Phone:314-484-6198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050400101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical