1023033990 NPI number — SYLVIA V HERDT LCSW

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023033990 NPI number — SYLVIA V HERDT LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERDT
Provider First Name:
SYLVIA
Provider Middle Name:
V
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023033990
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2702 AMBASSADOR LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALENCIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16059-1457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-272-1984
Provider Business Mailing Address Fax Number:
153-082-0619

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2591 WEXFORD BAYNE RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SEWICKLEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15143-8676
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-272-1984
Provider Business Practice Location Address Fax Number:
153-082-0619
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 631569 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 202856 . This is a "UPMC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 673053 . This is a "BLUE CROSS BLUE SHIELD PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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