Healthcare Provider Details

I. General information

NPI: 1588648919
Provider Name (Legal Business Name): MICHAEL B EBERLIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2171 JERICHO TPKE. SUITE 250
COMMACK NY
11725
UM

IV. Provider business mailing address

2171 JERICHO TPKE STE 250
COMMACK NY
11725-2947
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone: 516-558-7490
  • Fax: 877-205-6740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number009143-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number0985434392
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: