Basic Information
Provider Information | |||||||||
NPI: | 1720189376 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | EINHORN | ||||||||
FirstName: | NORMA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 720 20TH ST # SR | ||||||||
Address2: |   | ||||||||
City: | VERO BEACH | ||||||||
State: | FL | ||||||||
PostalCode: | 329605442 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2035399519 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 720 20TH ST | ||||||||
Address2: |   | ||||||||
City: | VERO BEACH | ||||||||
State: | FL | ||||||||
PostalCode: | 329605442 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2035399519 | ||||||||
FaxNumber: | 2033582327 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/26/2006 | ||||||||
LastUpdateDate: | 08/22/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 000540 | CT | N |   | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YM0800X |   |   | Y |   | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
ID | Type | State | Issuer | Description | 004172920 | 05 | CT |   | MEDICAID |