Kenneth Eisenberger, LICSW, DCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LW00005218 Issued in WA

Practice address

1303 S O St
Port Angeles, WA 98363-1218

Phone

(360) 626-1457

Fax

(360) 626-1457

NPI assigned

Jul 27, 2005

Last updated

Jan 23, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1122422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705968000000",
    "number": "1881694321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17183 CLEAR CREEK RD NW",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983707225",
            "telephone_number": "360-626-1457",
            "fax_number": "360-626-1457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1303 S O ST",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983631218",
            "telephone_number": "360-626-1457",
            "fax_number": "360-626-1457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EISENBERGER",
        "first_name": "KENNETH",
        "name_prefix": "Mr.",
        "credential": "LICSW, DCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-27",
        "last_updated": "2024-01-23",
        "certification_date": "2024-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW00005218",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8511768",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "G8902184",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lillian Effie Easton, ARNP
• Sheila Renee Eastwood, MA
• Heidi Melosa Eberle, LMT
• Alyssa Edlund
• Elgita Eglite-Wilson, LMT
• Mark A Eisenstadt, MD
• Morsy El Samaluty, RPH
• Eleven Eleven Dental
• Audrey R Elias, P.T.
• Laura Lee Eliason, LMHCA

• Clinical Social Worker in Port Angeles, WA
• Providers in Port Angeles, WA by specialty
• Clinical Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.