Provider Demographics
NPI:1619977766
Name:EBEN, BARRY (PHD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:
Last Name:EBEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 12TH AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2438
Mailing Address - Country:US
Mailing Address - Phone:206-568-6858
Mailing Address - Fax:
Practice Address - Street 1:1820 12TH AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-2438
Practice Address - Country:US
Practice Address - Phone:206-568-6858
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00000757103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist