Healthcare Provider Details

I. General information

NPI: 1366678021
Provider Name (Legal Business Name): GINA R WESNER MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 WESTGATE DR SUITE 100
BETHLEHEM PA
18017-7480
US

IV. Provider business mailing address

2045 WESTGATE DR SUITE 100
BETHLEHEM PA
18017-7480
US

V. Phone/Fax

Practice location:
  • Phone: 484-895-4321
  • Fax:
Mailing address:
  • Phone: 484-895-4321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW128197
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: