Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PY5093 | FL |
Y | 103T00000X | Psychologist | PY5093 | FL |
N | 103TA0700X | Adult Development & Aging Psychologist | PY5093 | FL |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PY5093 | FL |
N | 103TR0400X | Rehabilitation Psychologist | PY5093 | FL |
NPI | 1578570909 |
---|---|
Provider Name | Dr. Deborah Ebener |
First Address | Tallahassee, FL 32312-8055 |
Second Address | Tallahassee, FL 32312-1766 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 01/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
59612 | BLUE CROSS BLUE SHIELD (01) | FL |