Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1041C0700X | Clinical Social Worker | C5883 | MS |
Y | 1041C0700X | Clinical Social Worker | LSW3826 | TN |
NPI | 1003142670 |
---|---|
Provider Name | Mrs. Ellen Schlossberg Eisen |
First Address | Germantown, TN 38138-1734 |
Second Address | Germantown, TN 38138-1734 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2009 |
Last Update Date | 02/11/2009 |