Provider Demographics
NPI:1245742469
Name:LAKE ERIE BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:LAKE ERIE BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHERIFIA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:HERON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-454-3192
Mailing Address - Street 1:3216 STATE ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2822
Mailing Address - Country:US
Mailing Address - Phone:814-454-3192
Mailing Address - Fax:814-454-3190
Practice Address - Street 1:3216 STATE ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508
Practice Address - Country:US
Practice Address - Phone:814-812-2633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-27
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4580042084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty