Provider Demographics
NPI:1497724397
Name:EISENHAUER, GLYN (PH D)
Entity type:Individual
Prefix:DR
First Name:GLYN
Middle Name:
Last Name:EISENHAUER
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 KENWORTHEY RD
Mailing Address - Street 2:
Mailing Address - City:SHOHOLA
Mailing Address - State:PA
Mailing Address - Zip Code:18458-4336
Mailing Address - Country:US
Mailing Address - Phone:570-296-2632
Mailing Address - Fax:
Practice Address - Street 1:629 NEWARK POMPTON TPKE
Practice Address - Street 2:
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444-1732
Practice Address - Country:US
Practice Address - Phone:973-839-5984
Practice Address - Fax:973-835-2321
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37F100096900106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist