MEDICARE: HEALING HEARTS MENDING MINDS 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	CW017221	PA

General Provider Information

NPI Number	:	1629403936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING HEARTS MENDING MINDS LLC

Provider Business Mailing Address
First Line	:	716 SAINT CLAIR ST
Second Line	:
City	:	LATROBE
State	:	PA
Zip	:	15650-2061
Country	:	US
Telephone Number	:	724-804-8806
Fax Number	:	724-694-5789

Provider Business Practice Location Address
First Line	:	220 PITTSBURGH ST
Second Line	:
City	:	DERRY
State	:	PA
Zip	:	15627-1091
Country	:	US
Telephone Number	:	724-804-8806
Fax Number	:	724-694-5789

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. ANNA MARIE STERRETT
Credential	:	LCSW
Telephone Number	:	724-804-8806

Provider Enumeration Date	:	09/05/2013
Last Update Date	:	09/05/2013

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