Provider Demographics
NPI:1659164366
Name:EBERSBERGER, AMANDA (MA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:EBERSBERGER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3709 WATSEKA AVE APT 312
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-4061
Mailing Address - Country:US
Mailing Address - Phone:661-714-5209
Mailing Address - Fax:
Practice Address - Street 1:3709 WATSEKA AVE APT 312
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-4061
Practice Address - Country:US
Practice Address - Phone:661-714-5209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18985101YM0800X
CA154174106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health