Healthcare Provider Details

I. General information

NPI: 1366438103
Provider Name (Legal Business Name): SHARON B BIETSCH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4918 LOCUST LANE
HARRISBURG PA
17109
US

IV. Provider business mailing address

200 NORTH 7TH ST
LEBANON PA
17046
US

V. Phone/Fax

Practice location:
  • Phone: 717-671-9610
  • Fax: 717-671-9680
Mailing address:
  • Phone: 717-273-1710
  • Fax: 717-273-1416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW122751
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW-015931
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: