Healthcare Provider Details

I. General information

NPI: 1104495670
Provider Name (Legal Business Name): PAIGE WOLST MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 03/15/2026
Certification Date: 03/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 W BROAD STREET 4TH FLOOR, PMB 7534
BETHLEHEM PA
18018
US

IV. Provider business mailing address

635 DELLWOOD ST
BETHLEHEM PA
18018-4306
US

V. Phone/Fax

Practice location:
  • Phone: 610-297-5589
  • Fax:
Mailing address:
  • Phone: 610-297-5589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number021557
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: