Healthcare Provider Details

I. General information

NPI: 1689605107
Provider Name (Legal Business Name): DAVID J WEBSTER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LINCOLN STREET
RIDGWAY PA
15853
US

IV. Provider business mailing address

110 LINCOLN STREET
RIDGWAY PA
15853
US

V. Phone/Fax

Practice location:
  • Phone: 814-776-2145
  • Fax: 814-776-1470
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW014959
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: