| Lake Erie Behavioral Health, Llc | |
|
3216 State St Erie PA 16508 | |
| (814) 812-2633 | |
| Not Available |
| Full Name | Lake Erie Behavioral Health, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3216 State St, Erie, Pennsylvania |
| Authorized Official Name and Position | Sherifia Elaine Heron (CEO) |
| Authorized Official Contact | 8144543192 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Erie Behavioral Health, Llc 3216 State St Erie PA 16508-2822 Ph: (814) 454-3192 | Lake Erie Behavioral Health, Llc 3216 State St Erie PA 16508 Ph: (814) 812-2633 |
| NPI Number | 1245742469 |
|---|---|
| Provider Enumeration Date | 10/27/2017 |
| Last Update Date | 11/17/2020 |
| Certification Date | 11/17/2020 |
| Medicare PECOS PAC ID | 1658631627 |
|---|---|
| Medicare Enrollment ID | O20180213000156 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245742469 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | MD458004 (Pennsylvania) | Primary |
| Provider Name | Sherifia Heron |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1023375250 PECOS PAC ID: 8325282692 Enrollment ID: I20160826000255 |
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