Provider Demographics
NPI:1578570909
Name:EBENER, DEBORAH (PHD, CRC, NCC)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:EBENER
Suffix:
Gender:F
Credentials:PHD, CRC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 KIDDER CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-8055
Mailing Address - Country:US
Mailing Address - Phone:850-893-7335
Mailing Address - Fax:
Practice Address - Street 1:1334 TIMBERLANE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-1766
Practice Address - Country:US
Practice Address - Phone:850-766-1669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5093103T00000X, 103TA0700X, 103TC2200X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59612OtherBLUE CROSS BLUE SHIELD
FL59612Medicare ID - Type Unspecified