Provider Demographics
NPI:1528121431
Name:EBERT, RONALD S (PHD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:S
Last Name:EBERT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 FORBES RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-2706
Mailing Address - Country:US
Mailing Address - Phone:781-843-8100
Mailing Address - Fax:
Practice Address - Street 1:222 FORBES RD
Practice Address - Street 2:SUITE 105
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-2706
Practice Address - Country:US
Practice Address - Phone:781-843-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1308103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW01592Medicare ID - Type Unspecified