Healthcare Provider Details

I. General information

NPI: 1235229170
Provider Name (Legal Business Name): SHARON ZAFFARESE-DIPPOLD PHD, LCSW-R, LCSW, L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 09/29/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N. MICHAEL ST. SUITE 101
SAINT MARYS PA
15857-1327
US

IV. Provider business mailing address

PO BOX 783
SAINT MARYS PA
15857-0783
US

V. Phone/Fax

Practice location:
  • Phone: 814-834-4016
  • Fax: 814-834-1309
Mailing address:
  • Phone: 814-834-4016
  • Fax: 814-834-1309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number069192- R
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW020968
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: