| Doctor Name: | JOHN D EICHENBERGER |
| NPI Number: | 1093187288 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | L.M.H.C., C.A.S.A.C. |
| License Number: | 17971 |
| Business Practice Address: | 625 Cross Keys Office Park Building 600 Suite 625 Fairport, NY - 144503508 |
| Business Phone Number: | 5854252840 |
| Business Fax Number: | 5854252196 |
| Mailing Address: | 625 Cross Keys Office Park, Building 600 Suite 625 FAIRPORT |
| State: | NY |
| Postal Code: | 144503508 |
| Phone Number: | 5854252840 |
| Fax Number: | 5854252196 |
| NPI Enumeration Date: | 10/27/2015 |
| NPI Last Update Date: | 10/27/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 17971 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |