Provider Demographics
NPI:1679210603
Name:LANCE HERSHBERGER, LISW, LLC
Entity Type:Organization
Organization Name:LANCE HERSHBERGER, LISW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:HERSHBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:LISW, LCSW
Authorized Official - Phone:412-219-7113
Mailing Address - Street 1:21380 LORAIN RD STE 102
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-2144
Mailing Address - Country:US
Mailing Address - Phone:412-219-7113
Mailing Address - Fax:440-435-8894
Practice Address - Street 1:21380 LORAIN RD STE 102
Practice Address - Street 2:
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-2144
Practice Address - Country:US
Practice Address - Phone:412-219-7113
Practice Address - Fax:440-435-8894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty