Provider Demographics
NPI:1760091326
Name:SIPE, GREGORY ALEXANDER (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:ALEXANDER
Last Name:SIPE
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 1:441 BEAVER ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-1676
Mailing Address - Country:US
Mailing Address - Phone:412-324-2598
Mailing Address - Fax:
Practice Address - Street 1:441 BEAVER ST STE 201
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-1676
Practice Address - Country:US
Practice Address - Phone:412-324-2598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0209921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACW020992OtherLCSW LICENSE NUMBER