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General NPI Number Information
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NPI Number | 1093478364
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Entity Type | Individual
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Provider Name | TAMARA EBNER CPRS/CADC INTERN
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Gender | Female
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Dates
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Enumeration Date | 10/14/2021
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Last Update Date | 06/07/2023
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Provider Practice Location Address
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Address Line | 725 AIRPORT RD
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City | LAKEWOOD
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State | NJ
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Zip | 08701-5968
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Country | US
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Telephone | 327-367-4700
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Fax |
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Provider Business Mailing Address
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Address Line | 16 SHEEPSHEAD DR
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City | TOMS RIVER
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State | NJ
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Zip | 08757-5820
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Country | US
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Telephone | 732-500-6953
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | AD-GTL-21-02309
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License Number State | NJ
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