Provider Demographics
NPI:1164787172
Name:WILER, BRENDA LEORA (LSW)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:LEORA
Last Name:WILER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 WEST RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506
Mailing Address - Country:US
Mailing Address - Phone:814-923-7100
Mailing Address - Fax:814-838-7743
Practice Address - Street 1:3939 WEST RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506
Practice Address - Country:US
Practice Address - Phone:814-923-7100
Practice Address - Fax:814-838-7743
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW129386104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker