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NPI Code Detail

MEDICARE: EDNA STICKELL LCSW

MEDICARE:   EDNA  STICKELL  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
1101Y00000XCounselorCW016547PA

General Provider Information

NPI Number : 1639572076
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDNA STICKELL LCSW
Provider Business Mailing Address
First Line : 2185 W 8TH ST
Second Line :
City : ERIE
State : PA
Zip : 16505-4747
Country : US
Telephone Number : 814-464-8311
Fax Number : 814-464-8462
Provider Business Practice Location Address
First Line : 2911 STATE ST
Second Line :
City : ERIE
State : PA
Zip : 16508-1831
Country : US
Telephone Number : 814-464-8311
Fax Number : 814-464-8462
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2014
Last Update Date : 09/30/2014

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Directions to “ EDNA STICKELL LCSW” Practice Location

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