Provider Demographics
NPI:1366615882
Name:EHRENSBERGER, LISA M (BSED)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:EHRENSBERGER
Suffix:
Gender:F
Credentials:BSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 OLD NATIONAL PIKE
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15333-2114
Mailing Address - Country:US
Mailing Address - Phone:724-632-6801
Mailing Address - Fax:724-632-6312
Practice Address - Street 1:501 MCKEAN AVE
Practice Address - Street 2:
Practice Address - City:CHARLEROI
Practice Address - State:PA
Practice Address - Zip Code:15022-1558
Practice Address - Country:US
Practice Address - Phone:724-483-3081
Practice Address - Fax:724-483-5856
Is Sole Proprietor?:No
Enumeration Date:2008-04-04
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007288440097Medicaid
PA328834A932537OtherVALUE BEHAVIORAL HEALTH