Provider Demographics
NPI:1760212922
Name:EBSTEIN, JOEL (BT)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:EBSTEIN
Suffix:
Gender:M
Credentials:BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 5TH AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-1673
Mailing Address - Country:US
Mailing Address - Phone:415-823-4059
Mailing Address - Fax:
Practice Address - Street 1:2309 5TH AVE APT 302
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-1673
Practice Address - Country:US
Practice Address - Phone:415-823-4059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician