Provider Demographics
NPI:1255967550
Name:CARRIE EBERHARDY, LCSW LLC
Entity type:Organization
Organization Name:CARRIE EBERHARDY, LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:EBERHARDY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:505-819-3253
Mailing Address - Street 1:369 MONTEZUMA AVE # 379
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-2835
Mailing Address - Country:US
Mailing Address - Phone:505-819-3253
Mailing Address - Fax:
Practice Address - Street 1:3600 CERRILLOS RD STE 724E
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-2690
Practice Address - Country:US
Practice Address - Phone:505-819-3253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-18
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health