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General NPI Number Information
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NPI Number | 1538667258
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Entity Type | Individual
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Provider Name | JASEN M EBERZ LCSW
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Gender | Male
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Dates
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Enumeration Date | 01/28/2018
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 400 N CENTER DR STE 100
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City | NORFOLK
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State | VA
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Zip | 23502-0002
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Country | US
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Telephone | 757-908-3754
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Fax |
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Provider Business Mailing Address
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Address Line | 3977 PLEASANT VALLEY RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-8863
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Country | US
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Telephone | 703-801-1923
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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 | 0904010333
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License Number State | VA
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