Provider Demographics
NPI:1477368306
Name:EISENBERG, HALLIE
Entity type:Individual
Prefix:
First Name:HALLIE
Middle Name:
Last Name:EISENBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 W 17TH ST APT 542
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-5818
Mailing Address - Country:US
Mailing Address - Phone:908-616-2277
Mailing Address - Fax:
Practice Address - Street 1:430 W MERRICK RD STE 17
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5201
Practice Address - Country:US
Practice Address - Phone:908-616-2227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health