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General NPI Number Information
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NPI Number | 1164757902
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Entity Type | Individual
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Provider Name | MARIAN C EBERLY RN, LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/13/2009
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Last Update Date | 11/09/2009
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Provider Practice Location Address
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Address Line | 12612 N BLACK CANYON HWY
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City | PHOENIX
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State | AZ
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Zip | 85029-1345
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Country | US
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Telephone | 623-252-7433
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Fax |
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Provider Business Mailing Address
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Address Line | 12612 N BLACK CANYON HWY
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City | PHOENIX
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State | AZ
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Zip | 85029-1345
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Country | US
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Telephone | 623-252-7433
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-4127
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | RN058888
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License Number State | AZ
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