Provider Demographics
NPI:1659181071
Name:EILENBERGER, DEANNA MARIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:MARIE
Last Name:EILENBERGER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 RAILROAD ST APT 129W
Mailing Address - Street 2:
Mailing Address - City:SLATERSVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02876-8059
Mailing Address - Country:US
Mailing Address - Phone:570-269-9456
Mailing Address - Fax:
Practice Address - Street 1:1 HOPPIN ST STE 301
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4141
Practice Address - Country:US
Practice Address - Phone:570-269-9456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS020260103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical