Healthcare Provider Details

I. General information

NPI: 1396756466
Provider Name (Legal Business Name): WILLIAM B. YOCKEY MSW,LCSW,BCD, LISW-S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 03/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14513 S TOWNLINE RD
LINESVILLE PA
16424-5953
US

IV. Provider business mailing address

14513 S TOWNLINE RD
LINESVILLE PA
16424-5953
US

V. Phone/Fax

Practice location:
  • Phone: 814-683-4756
  • Fax:
Mailing address:
  • Phone: 814-683-4756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW002449L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.0900161-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: