Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 1415 | MA |
N | 101YP1600X | Pastoral Counselor | 1415 | MA |
NPI | 1336418037 |
---|---|
Provider Name | Fred I Eisen |
First Address | Amherst, MA 01002-1690 |
Second Address | Amherst, MA 01002-1690 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2011 |
Last Update Date | 26/12/2011 |