Provider Demographics
NPI:1669862678
Name:GILBERT-EBERT, ALYSON MARIE
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:MARIE
Last Name:GILBERT-EBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALYSON
Other - Middle Name:MARIE
Other - Last Name:EBERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:246 MAHOGANY PL
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18067-9270
Mailing Address - Country:US
Mailing Address - Phone:610-844-4664
Mailing Address - Fax:
Practice Address - Street 1:3975 TOWNSHIP LINE RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-9467
Practice Address - Country:US
Practice Address - Phone:610-866-6667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH002218101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health