MEDICARE: DR. SHARON ZAFFARESE-DIPPOLD PHD, LCSW-R, LCSW, L

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	069192- R	NY
2	1041C0700X	Clinical Social Worker	CW020968	PA

General Provider Information

NPI Number	:	1235229170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHARON ZAFFARESE-DIPPOLD PHD, LCSW-R, LCSW, L

Provider Business Mailing Address
First Line	:	PO BOX 783
Second Line	:
City	:	SAINT MARYS
State	:	PA
Zip	:	15857-0783
Country	:	US
Telephone Number	:	814-834-4016
Fax Number	:	814-834-1309

Provider Business Practice Location Address
First Line	:	105 N. MICHAEL ST. SUITE 101
Second Line	:
City	:	SAINT MARYS
State	:	PA
Zip	:	15857-1327
Country	:	US
Telephone Number	:	814-834-4016
Fax Number	:	814-834-1309

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	09/29/2022

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