Provider Demographics
NPI:1952491003
Name:WEIDENHAMER, WALTER WESLEY I (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:WESLEY
Last Name:WEIDENHAMER
Suffix:I
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 FOREST RD
Mailing Address - Street 2:
Mailing Address - City:BRADFORDWOODS
Mailing Address - State:PA
Mailing Address - Zip Code:15015-1201
Mailing Address - Country:US
Mailing Address - Phone:412-585-2319
Mailing Address - Fax:724-799-8660
Practice Address - Street 1:207 SPRING AVE
Practice Address - Street 2:
Practice Address - City:ELLWOOD CITY
Practice Address - State:PA
Practice Address - Zip Code:16117
Practice Address - Country:US
Practice Address - Phone:412-585-2319
Practice Address - Fax:724-799-8660
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW013823101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA286645OtherVALUEBEHAVIORALHEALTHOFPA
PA0856950OtherAETNA BEHAVIORAL HEALTH
PA0078145020002Medicaid
PA052548000OtherMAGELLAN HEALTH SERVICES
PA286645OtherVALUE OPTIONS
PA706894OtherHIGHMARK BC/BS INS. CO.
PA0856950OtherAETNA BEHAVIORAL HEALTH
PA0856950OtherAETNA BEHAVIORAL HEALTH
PA177042OtherMANAGED HEALTH NETWORK