Healthcare Provider Details

I. General information

NPI: 1326215963
Provider Name (Legal Business Name): JENNIFER HOPE AUSTAD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 ALWINE AVE
GREENSBURG PA
15601-3209
US

IV. Provider business mailing address

113 ALWINE AVE
GREENSBURG PA
15601-3209
US

V. Phone/Fax

Practice location:
  • Phone: 724-396-2862
  • Fax: 724-836-6197
Mailing address:
  • Phone: 724-396-2862
  • Fax: 724-836-6197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW124552
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW124552
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberSW124552
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCW015870
License Number StatePA
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW015870
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberCW015870
License Number StatePA
# 7
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCW015870
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: