Provider Demographics
NPI:1245446798
Name:EISENBERG, LESLEY (MSW)
Entity type:Individual
Prefix:MRS
First Name:LESLEY
Middle Name:
Last Name:EISENBERG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 HIGHVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5130
Mailing Address - Country:US
Mailing Address - Phone:203-847-0661
Mailing Address - Fax:203-803-4747
Practice Address - Street 1:9 MOTT AVE STE 310
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3337
Practice Address - Country:US
Practice Address - Phone:203-952-4011
Practice Address - Fax:203-803-4747
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002492104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008036561Medicaid