Individual provider Active NPI

Michael Eisenberg

  • Clinical Social Worker
  • New Britain, CT
National Provider Identifier
1417476482
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
11106 Issued in CT
Practice address
85 Lafayette St
New Britain, CT 06051-1803
Phone
(860) 224-3642
NPI assigned
Sep 11, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 11106 CT
Clinical Social Worker 1041C0700X 11106 CT Primary

Addresses

Primary practice location

85 Lafayette St
New Britain, CT 06051-1803

Mailing address

43 Woodland St
Hartford, CT 06105-2363

Other practice location 1

43 Woodland St
Hartford, CT 06105-2363
Phone (860) 793-3500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240311001763 CT Practitioner - Clinical Social Worker 4688010887 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11106CTMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Center Inc CurrentSince Apr 1, 2024 Accepting new patients
Community Health Center Inc Clinical CurrentSince Apr 1, 2024 Accepting new patients

Locations

19 Grand St
Middletown, CT 06457
Phone (860) 323-0172

85 Lafayette St
New Britain, CT 06051
Phone (860) 224-3642

Interoperability endpoints

  • Direct secure messaging: michael.eisenberg@chcict.eclinicaldirectplus.com
  • Direct secure messaging: michael.eisenberg.p1@direct.wheelerclinic.nextgenshare.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1505088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724112000000",
    "number": "1417476482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43 WOODLAND ST",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061052363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 LAFAYETTE ST",
            "city": "NEW BRITAIN",
            "state": "CT",
            "postal_code": "060511803",
            "telephone_number": "860-224-3642"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "43 Woodland St",
            "address_purpose": "LOCATION",
            "city": "Hartford",
            "state": "CT",
            "postal_code": "061052363",
            "country_code": "US",
            "telephone_number": "860-793-3500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EISENBERG",
        "first_name": "MICHAEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-11",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CT",
            "license": "11106",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "11106",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Britain, CT

Sources for this page

Verify at the official NPI Registry.