Provider Demographics
NPI:1093075012
Name:GWINN, ISAIAH (LCSW)
Entity Type:Individual
Prefix:
First Name:ISAIAH
Middle Name:
Last Name:GWINN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4945
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-0945
Mailing Address - Country:US
Mailing Address - Phone:412-945-0745
Mailing Address - Fax:
Practice Address - Street 1:204 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3026
Practice Address - Country:US
Practice Address - Phone:412-661-7790
Practice Address - Fax:412-661-7790
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0193111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical