Healthcare Provider Details

I. General information

NPI: 1306800420
Provider Name (Legal Business Name): JOHN W ILLINGWORTH M.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 05/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4311 EASTON AVE
BETHLEHEM PA
18020-1431
US

IV. Provider business mailing address

4311 EASTON AVE
BETHLEHEM PA
18020-1431
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-2400
  • Fax: 484-526-3697
Mailing address:
  • Phone: 484-526-2400
  • Fax: 484-526-3697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: