Provider Demographics
NPI:1760353452
Name:EBNER, SARA (PHD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:EBNER
Suffix:
Gender:X
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7413 US HIGHWAY 42 STE 3
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1999
Mailing Address - Country:US
Mailing Address - Phone:859-869-4463
Mailing Address - Fax:859-869-4476
Practice Address - Street 1:7413 US HIGHWAY 42 STE 3
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1999
Practice Address - Country:US
Practice Address - Phone:859-869-4463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-15
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY295414103T00000X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1467997361OtherNPI