Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY-005404 | AZ |
Y | 103TC0700X | Clinical Psychologist | PSY-005404 | AZ |
N | 102L00000X | Psychologist | LP5910 | MN |
N | 103T00000X | Psychologist | LP5910 | MN |
NPI | 1003265786 |
---|---|
Provider Name | Efrat Eichenbaum |
First Address | Phoenix, AZ 85013-4423 |
Second Address | Phoenix, AZ 85013-4423 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2016 |
Last Update Date | 12/11/2021 |