Healthcare Provider Details

I. General information

NPI: 1952491003
Provider Name (Legal Business Name): WALTER WESLEY WEIDENHAMER I M.S.W., L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 03/12/2024
Certification Date: 03/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 SPRING AVE
ELLWOOD CITY PA
16117
US

IV. Provider business mailing address

71 FOREST RD
BRADFORDWOODS PA
15015-1201
US

V. Phone/Fax

Practice location:
  • Phone: 412-585-2319
  • Fax: 724-799-8660
Mailing address:
  • Phone: 412-585-2319
  • Fax: 724-799-8660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCW013823
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: