Provider Demographics
NPI:1568204923
Name:FRYBERGER, ELIZABETH ANNA (BCBA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNA
Last Name:FRYBERGER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 HEATHMORE AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15227-3225
Mailing Address - Country:US
Mailing Address - Phone:717-571-1413
Mailing Address - Fax:
Practice Address - Street 1:103 HEATHMORE AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15227-3225
Practice Address - Country:US
Practice Address - Phone:717-571-1413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH005509103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst