Provider Demographics
NPI:1285303552
Name:EBERTS, GENE H
Entity type:Individual
Prefix:DR
First Name:GENE
Middle Name:H
Last Name:EBERTS
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:GENE
Other - Middle Name:H
Other - Last Name:EBERTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:216 VICTORY LN
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-5432
Mailing Address - Country:US
Mailing Address - Phone:410-420-2826
Mailing Address - Fax:
Practice Address - Street 1:216 VICTORY LN
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-5432
Practice Address - Country:US
Practice Address - Phone:410-420-2826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01321103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist