| Doctor Name: | DR. TERRY EISENBERG CARRILIO |
| NPI Number: | 1871994350 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 0904006813 |
| Business Practice Address: | 949 Palm Ave Imperial Beach, CA - 919321503 |
| Business Phone Number: | 6194293733 |
| Business Fax Number: | |
| Mailing Address: | 2127 Olympic Pkwy, Suite 1006-110 CHULA VISTA |
| State: | CA |
| Postal Code: | 919151359 |
| Phone Number: | 6199172188 |
| Fax Number: | |
| NPI Enumeration Date: | 09/15/2014 |
| NPI Last Update Date: | 09/15/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 0904006813 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | VA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |