Provider Demographics
NPI:1891853289
Name:EBERSBERGER, JOHN MATTHEW (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MATTHEW
Last Name:EBERSBERGER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 MISSION AVE
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-5857
Mailing Address - Country:US
Mailing Address - Phone:916-734-5819
Mailing Address - Fax:916-734-0616
Practice Address - Street 1:3700 BUSINESS DR STE 130
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-2164
Practice Address - Country:US
Practice Address - Phone:916-734-5819
Practice Address - Fax:916-734-0616
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS18955251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA171M00000XMedicaid
CA101YP25DOXMedicaid