MEDICARE: JODIE F. WITHERITE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CW015755	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2093219	OTHER	CIGNA
2	349437000	OTHER	MAGELLAN
3	0230054	OTHER	ANTHEM BC/BS

General Provider Information

NPI Number	:	1972578292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODIE F. WITHERITE LCSW

Provider Business Mailing Address
First Line	:	699 E STATE ST
Second Line	:
City	:	SHARON
State	:	PA
Zip	:	16146-2057
Country	:	US
Telephone Number	:	724-983-3820
Fax Number	:	724-983-3941

Provider Business Practice Location Address
First Line	:	551 GREENVILLE RD
Second Line	:
City	:	MERCER
State	:	PA
Zip	:	16137-5019
Country	:	US
Telephone Number	:	724-662-3831
Fax Number	:	724-662-3836

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	08/27/2008

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