Provider Demographics
NPI:1457608309
Name:EISENBERG, SHIRA (MA, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:SHIRA
Middle Name:
Last Name:EISENBERG
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 SCHERMERHORN ST
Mailing Address - Street 2:APT 12C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-6096
Mailing Address - Country:US
Mailing Address - Phone:917-559-3076
Mailing Address - Fax:
Practice Address - Street 1:189 SCHERMERHORN ST
Practice Address - Street 2:APT 12C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-6096
Practice Address - Country:US
Practice Address - Phone:917-559-3076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1859765174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist