Provider Demographics
NPI:1477149227
Name:EBNER, JILLIAN (RBT)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:EBNER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3030 GRAFTON LN
Mailing Address - Street 2:
Mailing Address - City:CHURCHVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21028-1723
Mailing Address - Country:US
Mailing Address - Phone:410-776-4640
Mailing Address - Fax:410-734-6460
Practice Address - Street 1:1106 REVOLUTION ST
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3721
Practice Address - Country:US
Practice Address - Phone:410-776-4640
Practice Address - Fax:410-734-6460
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-20-148095106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician