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NPI Code Detail

MEDICARE: SANDY WILSON LCSW

MEDICARE:   SANDY  WILSON  LCSW
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
11041C0700XClinical Social WorkerCW019889PA

General Provider Information

NPI Number : 1285173054
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDY WILSON LCSW
Provider Business Mailing Address
First Line : PO BOX 308
Second Line :
City : REPUBLIC
State : PA
Zip : 15475-0308
Country : US
Telephone Number : 724-963-6137
Fax Number :
Provider Business Practice Location Address
First Line : 627 PITTSBURGH RD STE 2
Second Line :
City : UNIONTOWN
State : PA
Zip : 15401-2200
Country : US
Telephone Number : 734-439-4990
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2017
Last Update Date : 02/01/2021

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Directions to “ SANDY WILSON LCSW” Practice Location

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