Provider Demographics
NPI:1649250184
Name:HERRENKOHL, ELLEN C (PHD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:C
Last Name:HERRENKOHL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 E ELIZABETH AVE
Mailing Address - Street 2:SUITE 608
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-6518
Mailing Address - Country:US
Mailing Address - Phone:610-868-0625
Mailing Address - Fax:610-625-5832
Practice Address - Street 1:65 E ELIZABETH AVE
Practice Address - Street 2:SUITE 608
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-6518
Practice Address - Country:US
Practice Address - Phone:610-868-0625
Practice Address - Fax:610-625-5832
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS000796-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0051300000OtherINDEPENDENCE BLUE CROSS
PA02437700OtherCAPITOL BLUE CROSS
PA30631OtherPA BLUE SHIELD
PA0005780270OtherAETNA
PA0005780270OtherAETNA