Healthcare Provider Details

I. General information

NPI: 1184279846
Provider Name (Legal Business Name): SAGE WINDEMAKER, LCSW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 KENNETT PIKE STE 205B
CHADDS FORD PA
19317-8217
US

IV. Provider business mailing address

4 WALNUT DR
LINCOLN UNIVERSITY PA
19352-8920
US

V. Phone/Fax

Practice location:
  • Phone: 717-364-0385
  • Fax:
Mailing address:
  • Phone: 717-364-0385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SAGE WINDEMAKER
Title or Position: OWNER, CLINICAL DIRECTOR, THERAPIST
Credential: LCSW
Phone: 717-364-0385