Healthcare Provider Details

I. General information

NPI: 1295521458
Provider Name (Legal Business Name): SIDNEY LYNN FRESHWATER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 VIP DR STE 310
WEXFORD PA
15090-6936
US

IV. Provider business mailing address

111 FREDERICK RD
BADEN PA
15005-2317
US

V. Phone/Fax

Practice location:
  • Phone: 724-934-3905
  • Fax:
Mailing address:
  • Phone: 607-333-2323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: