Provider Demographics
NPI:1962668483
Name:WALDRON, JODI LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:LYNN
Last Name:WALDRON
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 1:2508 BLUE JAY DR
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-8413
Mailing Address - Country:US
Mailing Address - Phone:919-279-0624
Mailing Address - Fax:
Practice Address - Street 1:35 E ELIZABETH AVE
Practice Address - Street 2:SUITE 37
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-6505
Practice Address - Country:US
Practice Address - Phone:610-865-1303
Practice Address - Fax:610-865-9632
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0174541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical