Healthcare Provider Details

I. General information

NPI: 1578570909
Provider Name (Legal Business Name): DEBORAH EBENER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 W CALL ST STE 3210
TALLAHASSEE FL
32306-1766
US

IV. Provider business mailing address

1114 W CALL ST STE 3210
TALLAHASSEE FL
32304-3476
US

V. Phone/Fax

Practice location:
  • Phone: 850-644-3611
  • Fax:
Mailing address:
  • Phone: 850-644-3611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberPY5093
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPY5093
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY5093
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY5093
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: