Provider Demographics
NPI:1174652085
Name:EHRENBERG, THOMAS (LCMHC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:EHRENBERG
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 MAIN ST
Mailing Address - Street 2:# 14
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-3908
Mailing Address - Country:US
Mailing Address - Phone:802-257-7827
Mailing Address - Fax:
Practice Address - Street 1:67 MAIN ST
Practice Address - Street 2:# 14
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-3908
Practice Address - Country:US
Practice Address - Phone:802-257-7827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT118101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1011032Medicaid
VT18260OtherBCBSVT