Provider Demographics
NPI:1508524984
Name:EBERHARDT, JENNIFER ROBERTINE (LMSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROBERTINE
Last Name:EBERHARDT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 RANDALL AVE APT 2H
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-2715
Mailing Address - Country:US
Mailing Address - Phone:516-695-4488
Mailing Address - Fax:
Practice Address - Street 1:1051 WANTAGH AVE
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-2109
Practice Address - Country:US
Practice Address - Phone:516-785-0323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113940104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker