Provider Demographics
NPI:1396167458
Name:EISNER, SCOTT JEFFREY (MA)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:JEFFREY
Last Name:EISNER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:MR
Other - First Name:SCOTT
Other - Middle Name:JEFFREY
Other - Last Name:EISNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:71 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809-2223
Mailing Address - Country:US
Mailing Address - Phone:774-644-5138
Mailing Address - Fax:
Practice Address - Street 1:108 N FRONT ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-7327
Practice Address - Country:US
Practice Address - Phone:774-626-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-09
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst