Provider Demographics
NPI:1639572076
Name:STICKELL, EDNA (LCSW)
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:
Last Name:STICKELL
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 1:2185 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4747
Mailing Address - Country:US
Mailing Address - Phone:814-464-8311
Mailing Address - Fax:814-464-8462
Practice Address - Street 1:2911 STATE ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-1831
Practice Address - Country:US
Practice Address - Phone:814-464-8311
Practice Address - Fax:814-464-8462
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW016547101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor