=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174173199
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELLEN BEWARD LSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2019
-----------------------------------------------------
Last Update Date | 09/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 516 W 4TH ST
-----------------------------------------------------
City | LEWISTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17044-2083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-363-4973
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25 HILL ST
-----------------------------------------------------
City | MILROY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17063-8640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-953-4888
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | SW137759
-----------------------------------------------------
License Number State |
-----------------------------------------------------