Provider Demographics
NPI:1235100256
Name:HERLITSCHEK, SANDRA G (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:G
Last Name:HERLITSCHEK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 STERNERS RD
Mailing Address - Street 2:
Mailing Address - City:GREEN LANE
Mailing Address - State:PA
Mailing Address - Zip Code:18054-2550
Mailing Address - Country:US
Mailing Address - Phone:215-453-1321
Mailing Address - Fax:
Practice Address - Street 1:2110 STERNERS RD
Practice Address - Street 2:
Practice Address - City:GREEN LANE
Practice Address - State:PA
Practice Address - Zip Code:18054-2550
Practice Address - Country:US
Practice Address - Phone:215-453-1321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW002736-L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical