Individual
DR. ETHAN EISEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
107 LAKESIDE DR E, LAWRENCE, NY 11559-1718
(516) 259-3148
Mailing address
107 LAKESIDE DR E, LAWRENCE, NY 11559-1718
(516) 259-3148
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
05837
MD
Other
Enumeration date
10/08/2020
Last updated
10/08/2020
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