Healthcare Provider Details

I. General information

NPI: 1114455227
Provider Name (Legal Business Name): SABRINA A KOTRICK MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 CHESTNUT AVE
NORTHERN CAMBRIA PA
15714-1462
US

IV. Provider business mailing address

802 CHESTNUT AVE
NORTHERN CAMBRIA PA
15714-1462
US

V. Phone/Fax

Practice location:
  • Phone: 814-241-6520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW133971
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: