Provider Demographics
NPI:1285832766
Name:EBERT, SHIRLEYAN (LCSW)
Entity Type:Individual
Prefix:
First Name:SHIRLEYAN
Middle Name:
Last Name:EBERT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-1076
Mailing Address - Country:US
Mailing Address - Phone:518-587-8800
Mailing Address - Fax:518-583-3311
Practice Address - Street 1:254 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-1076
Practice Address - Country:US
Practice Address - Phone:518-587-8800
Practice Address - Fax:518-583-3311
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR042603-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical