Provider Demographics
NPI:1558604009
Name:EBERHART, DEIRDRE MARIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DEIRDRE
Middle Name:MARIE
Last Name:EBERHART
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 1:3632 WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ENDWELL
Mailing Address - State:NY
Mailing Address - Zip Code:13760-1635
Mailing Address - Country:US
Mailing Address - Phone:321-831-8455
Mailing Address - Fax:607-238-3731
Practice Address - Street 1:27241 STATE ROUTE 267
Practice Address - Street 2:
Practice Address - City:FRIENDSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18818-8640
Practice Address - Country:US
Practice Address - Phone:607-669-2583
Practice Address - Fax:607-238-3731
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2020-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY088469-11041C0700X
FLSW130041041C0700X
PACW0203481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical