Ryan Craig Ebersole, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

023865 Issued in NY

Practice address

2 Clara Barton Dr # MC-164
Albany, NY 12208-3472

Phone

(518) 262-5511

Fax

(518) 262-6111

NPI assigned

Apr 15, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Athenapsych LLC

  • Psychiatry Physician
  • Bronx, NY
  • NPI 1679244768
  Medicare reassignment NPD
• Athenapsych LLC

  • Case Management Agency
  • New York, NY
  • NPI 1295625788
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599782400000",
    "number": "1255950614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 CLARA BARTON DR # MC-164",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122083472",
            "telephone_number": "518-262-5511",
            "fax_number": "518-262-6111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 CLARA BARTON DR # MC-164",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122083472",
            "telephone_number": "518-262-5511",
            "fax_number": "518-262-6111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBERSOLE",
        "first_name": "RYAN",
        "middle_name": "CRAIG",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-15",
        "last_updated": "2020-09-11",
        "certification_date": "2020-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "023865",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carolyn Ann Eaton, M.D.
• Kimberly Allison Eaton, LMSW
• Mary D Eaton, MS.ED.
• Katherine M Eberhardt, NP
• Lisa Ann Eberhardt, FNP-BC
• Erina Eccher, D.D.S.
• Echo Speech Therapy, PLLC
• Eckardt Johanning, M.D., P.C.
• Eckerd Corporation
• Eckerd Corporation

• Clinical Psychologist in Albany, NY
• Providers in Albany, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.