MEDICARE: EMERGE WELLNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1154990653
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERGE WELLNESS LLC

Provider Business Mailing Address
First Line	:	1500 BROADWAY AVENUE
Second Line	:	APARTMENT 201
City	:	PITTSBURGH
State	:	PA
Zip	:	15216-3788
Country	:	US
Telephone Number	:	717-418-4797
Fax Number	:

Provider Business Practice Location Address
First Line	:	226 PAUL STREET
Second Line	:	SUITE 105
City	:	PITTSBURGH
State	:	PA
Zip	:	15211-2332
Country	:	US
Telephone Number	:	412-440-7441
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LAUREN STONER
Credential	:	LCSW
Telephone Number	:	717-418-4797

Provider Enumeration Date	:	06/21/2021
Last Update Date	:	06/21/2021

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