Healthcare Provider Details

I. General information

NPI: 1942630314
Provider Name (Legal Business Name): STEPHEN THOMAS WIZE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2013
Last Update Date: 11/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20399 RT 19, BRANDT DR, ONE LANDMARK NORTH SUITE 205A
CRANBERRY TOWNSHIP PA
16066-4139
US

IV. Provider business mailing address

20399 RT 19, BRANDT DR, ONE LANDMARK NORTH SUITE 205A
CRANBERRY TOWNSHIP PA
16066-4139
US

V. Phone/Fax

Practice location:
  • Phone: 724-544-0596
  • Fax: 724-772-8069
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW017900
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: