Provider Demographics
NPI:1568548691
Name:WOODWARD STEWART, BRANDIE ELLEN (MA, ATR-BC, LPC)
Entity Type:Individual
Prefix:
First Name:BRANDIE
Middle Name:ELLEN
Last Name:WOODWARD STEWART
Suffix:
Gender:F
Credentials:MA, ATR-BC, LPC
Other - Prefix:
Other - First Name:BRANDIE
Other - Middle Name:ELLEN
Other - Last Name:WOODWARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:236 E LOYALHANNA ST
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658-1316
Mailing Address - Country:US
Mailing Address - Phone:412-610-1471
Mailing Address - Fax:724-995-8367
Practice Address - Street 1:82 HUFF AVENUE EXT STE AB
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-5483
Practice Address - Country:US
Practice Address - Phone:724-834-4227
Practice Address - Fax:724-995-8637
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA02162101Y00000X
PAPC003350101YP2500X
PAPC0033550101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA494123OtherVALUE OPTIONS PROVIDER
PA202179940OtherTAX IDENTIFICATION
PA001491706OtherINDIVIDUAL HIGMARK NUMBER
PA494123OtherVALUE BEHAVIORAL PROVIDER