Dr. Ethan A Eisdorfer, PSYD
Psychologist, Clinical in Worcester, Massachusetts
1083864946- Practice location
- 55 Lake Ave N, Worcester, MA 01655-0002
- Phone
- 508-334-2731
- Fax
- 774-442-4672
- Last updated
- March 5, 2025
Ethan Aaron Eisdorfer is a Psychologist, Clinical based in Worcester, MA. Ethan Aaron Eisdorfer practices in Worcester, MA and has the professional credentials of PSYD. The NPI Number for Ethan Aaron Eisdorfer is 1083864946 and holds a License No. 11368 (MA). The current practice location address for Ethan Aaron Eisdorfer is 55 Lake Ave N, Worcester, MA 01655-0002 and can be reached out via phone at 508-334-2731 and via fax at 774-442-4672.
Provider Profile Details
- NPI Number
- 1083864946
- Provider Name
- Ethan Aaron Eisdorfer
- Credential
- PSYD
- Provider Entity Type
- Individual
- Gender
- Male
- Address
- 55 Lake Ave N, Worcester, MA 01655-0002
- Phone Number
- 508-334-2731
- Fax Number
- 774-442-4672
- Primary Taxonomy
- Psychologist, Clinical · 103TC0700X
- Sole Proprietor
- No
- Provider Enumeration Date
- September 26, 2008
- Last Update Date
- March 5, 2025
- Certification Date
- March 5, 2025
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 55 Lake Ave N
Worcester, MA 01655-0002 - City
- Worcester
- State
- Massachusetts
- Zip
- 01655-0002
- Phone Number
- 508-334-2731
- Fax Number
- 774-442-4672
Provider Business Mailing Address Details
- Address
- Po Box 415348
Boston, MA 02241-5348 - City
- Boston
- State
- MA
- Zip
- 02241-5348
- Phone Number
- 800-225-8885
License Information
- License Number
- 11368
- License State
- MA
- Taxonomy
- Psychologist, Clinical · 103TC0700X · Primary
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
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Frequently Asked Questions
What is the NPI number of Dr. Ethan A Eisdorfer, PSYD?
The NPI number of Dr. Ethan A Eisdorfer, PSYD is 1083864946. It was assigned on September 26, 2008 and is currently active in the NPPES registry.
What is the specialty of Dr. Ethan A Eisdorfer, PSYD?
Dr. Ethan A Eisdorfer, PSYD is registered under the primary taxonomy Psychologist, Clinical (code 103TC0700X), licensed in MA under license number 11368.
Where does Dr. Ethan A Eisdorfer, PSYD practice?
The practice location is 55 Lake Ave N, Worcester, MA 01655-0002. The office can be reached at 508-334-2731 (phone) or 774-442-4672 (fax).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1083864946 directly on the NPPES registry website.