Healthcare Provider Details

I. General information

NPI: 1174173199
Provider Name (Legal Business Name): ELLEN BEWARD LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2019
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 W 4TH ST
LEWISTOWN PA
17044-2083
US

IV. Provider business mailing address

25 HILL ST
MILROY PA
17063-8640
US

V. Phone/Fax

Practice location:
  • Phone: 717-363-4973
  • Fax:
Mailing address:
  • Phone: 717-953-4888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW137759
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: