Healthcare Provider Details

I. General information

NPI: 1548275027
Provider Name (Legal Business Name): ISLA M WURST MSS,LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 NEW HOLLAND AVE
LANCASTER PA
17602-2137
US

IV. Provider business mailing address

320 HIGHLAND DR
MOUNTVILLE PA
17554-1232
US

V. Phone/Fax

Practice location:
  • Phone: 717-390-0353
  • Fax:
Mailing address:
  • Phone: 717-285-7121
  • Fax: 717-285-2658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW013678
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: