Provider Demographics
NPI:1215664388
Name:BROBERG, ASHLEY E (LCSW)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:E
Last Name:BROBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1891 SANTA BARBARA DR STE 102
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4106
Mailing Address - Country:US
Mailing Address - Phone:717-553-1192
Mailing Address - Fax:
Practice Address - Street 1:1891 SANTA BARBARA DR STE 102
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4106
Practice Address - Country:US
Practice Address - Phone:717-553-1192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0252241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0085535Medicaid