Provider Demographics
NPI:1194424101
Name:EHRENBERG, CASEY LORAINE (MSW)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:LORAINE
Last Name:EHRENBERG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 SOUTHWINDS DR
Mailing Address - Street 2:
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-3976
Mailing Address - Country:US
Mailing Address - Phone:786-897-9827
Mailing Address - Fax:
Practice Address - Street 1:1586 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25405-5013
Practice Address - Country:US
Practice Address - Phone:304-267-0818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-28
Last Update Date:2023-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSW012316491104100000X
WVBP00946563104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker