Provider Demographics
NPI:1114052156
Name:DAVID, EPHRAT (LMHC, MFT)
Entity Type:Individual
Prefix:MRS
First Name:EPHRAT
Middle Name:
Last Name:DAVID
Suffix:
Gender:F
Credentials:LMHC, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WENDELL AVENUE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-1111
Mailing Address - Country:US
Mailing Address - Phone:413-212-9192
Mailing Address - Fax:413-274-3340
Practice Address - Street 1:100 WENDELL AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-6941
Practice Address - Country:US
Practice Address - Phone:413-212-9192
Practice Address - Fax:413-274-3340
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6297101YM0800X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist