Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Ethan Eisen, PHD

Individual provider Clinical Psychologist · NPI 1558968842

Dr. Ethan Eisen, PHD is a Clinical Psychologist in Lawrence, New York. Practices as a sole proprietor. Licensed in Maryland.

Licensed in
MD
In the registry since
2020
What do these letters mean?
PHD — Doctor of Philosophy
A research doctorate. In healthcare it usually sits alongside a clinical licence.

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Practice location Address checks out

107 Lakeside Dr E
Lawrence, NY 11559-1718
Phone: (516) 259-3148
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Psychologist (primary) Taxonomy 103TC0700X · Licence 05837 (MD)

Record details

NPI number1558968842
Entity typeIndividual (Type 1)
GenderMale
Credentials PHD
Sole proprietorYes
NPI enumeratedOctober 8, 2020
Last updated in NPPESOctober 8, 2020
Certification dateOctober 8, 2020
Mailing address107 Lakeside Dr E, Lawrence, NY 11559-1718

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