Provider Demographics
NPI:1457080640
Name:ERGENBRIGHT, DANA
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:ERGENBRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 BETHLEHEM PIKE REAR C
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-8247
Mailing Address - Country:US
Mailing Address - Phone:503-858-7618
Mailing Address - Fax:
Practice Address - Street 1:512 WEST AVE
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2725
Practice Address - Country:US
Practice Address - Phone:215-885-1835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional