Healthcare Provider Details

I. General information

NPI: 1962668483
Provider Name (Legal Business Name): JODI LYNN WALDRON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 E ELIZABETH AVE SUITE 37
BETHLEHEM PA
18018-6505
US

IV. Provider business mailing address

2508 BLUE JAY DR
NAZARETH PA
18064-8413
US

V. Phone/Fax

Practice location:
  • Phone: 610-865-1303
  • Fax: 610-865-9632
Mailing address:
  • Phone: 919-279-0624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW017454
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: