Provider Demographics
NPI:1073058178
Name:PENCE, DEBORAH W (LBS)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:W
Last Name:PENCE
Suffix:
Gender:F
Credentials:LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-2420
Mailing Address - Country:US
Mailing Address - Phone:724-728-8400
Mailing Address - Fax:
Practice Address - Street 1:1607 3RD ST
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2420
Practice Address - Country:US
Practice Address - Phone:724-728-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-27
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH003043106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABH003043OtherBEHAVIOR SPECIALIST