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General NPI Number Information
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NPI Number | 1891853289
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Entity Type | Individual
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Provider Name | JOHN MATTHEW EBERSBERGER LCSW
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Gender | Male
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 3700 BUSINESS DR STE 130
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City | SACRAMENTO
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State | CA
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Zip | 95820-2164
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Country | US
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Telephone | 916-734-5819
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Fax | 916-734-0616
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Provider Business Mailing Address
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Address Line | 1450 MISSION AVE
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City | CARMICHAEL
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State | CA
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Zip | 95608-5857
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Country | US
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Telephone | 916-734-5819
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Fax | 916-734-0616
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | LCS18955
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License Number State | CA
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