Healthcare Provider Details

I. General information

NPI: 1740280593
Provider Name (Legal Business Name): CARRIE BETH SESLOW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARRIE BETH SHIPLEY MSW

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 W MAIN ST
SOMERSET PA
15501-2037
US

IV. Provider business mailing address

138 W MAIN ST
SOMERSET PA
15501-2037
US

V. Phone/Fax

Practice location:
  • Phone: 814-443-4780
  • Fax: 814-443-4758
Mailing address:
  • Phone: 814-443-4780
  • Fax: 814-443-4758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW013358L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW015265
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: