Provider Demographics
NPI:1972578292
Name:WITHERITE, JODIE F (LCSW)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:F
Last Name:WITHERITE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JODIE
Other - Middle Name:F
Other - Last Name:HULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:699 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-2057
Mailing Address - Country:US
Mailing Address - Phone:724-983-3820
Mailing Address - Fax:724-983-3941
Practice Address - Street 1:551 GREENVILLE RD
Practice Address - Street 2:
Practice Address - City:MERCER
Practice Address - State:PA
Practice Address - Zip Code:16137-5019
Practice Address - Country:US
Practice Address - Phone:724-662-3831
Practice Address - Fax:724-662-3836
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0157551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
2093219OtherCIGNA
349437000OtherMAGELLAN
0230054OtherANTHEM BC/BS