Healthcare Provider Details

I. General information

NPI: 1578601191
Provider Name (Legal Business Name): ELIZABETH HARSHBERGER MA, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761 3RD ST
NEW MARTINSVILLE WV
26155-1403
US

IV. Provider business mailing address

761 3RD ST
NEW MARTINSVILLE WV
26155-1403
US

V. Phone/Fax

Practice location:
  • Phone: 304-455-3035
  • Fax: 304-455-3076
Mailing address:
  • Phone: 304-455-3035
  • Fax: 304-455-3076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCP00452448
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: