Provider Demographics
NPI:1023071693
Name:WIDDERSHEIM, DENNIS GEORGE (LCSW)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:GEORGE
Last Name:WIDDERSHEIM
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 1:1833 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-5729
Mailing Address - Country:US
Mailing Address - Phone:610-868-1387
Mailing Address - Fax:
Practice Address - Street 1:SOLUTIONS COUNSELING
Practice Address - Street 2:35 EAST ELIZABETH AVE. SUITE 37
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018
Practice Address - Country:US
Practice Address - Phone:610-865-1303
Practice Address - Fax:610-865-9632
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW000171L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA636655VLKMedicare PIN