Provider Demographics
NPI:1447359070
Name:EISEMAN, CAROLINE (LCSW)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:EISEMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 W 93RD ST
Mailing Address - Street 2:APARTMENT 3D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7233
Mailing Address - Country:US
Mailing Address - Phone:917-880-7602
Mailing Address - Fax:
Practice Address - Street 1:1669 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-2009
Practice Address - Country:US
Practice Address - Phone:718-467-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0727631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCE0N158X10Medicare ID - Type Unspecified