Alexandra Celeste Ebken, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CW020014 Issued in PA

Practice address

320 Rolling Ridge Dr Ste 100
State College, PA 16801

Phone

(814) 867-0670

Fax

(814) 867-7616

NPI assigned

Jul 27, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1311724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533081600000",
    "number": "1386922177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 ROLLING RIDGE DR STE 100",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168017641",
            "telephone_number": "814-867-0670",
            "fax_number": "814-867-7616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 ROLLING RIDGE DR STE 100",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "16801",
            "telephone_number": "814-867-0670",
            "fax_number": "814-867-7616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBKEN",
        "first_name": "ALEXANDRA",
        "middle_name": "CELESTE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-27",
        "last_updated": "2018-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "DC",
            "license": "LG50079458",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "PA",
            "license": "CW020014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in State College, PA
• Providers in State College, PA by specialty
• Clinical Social Worker in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2018; 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.