Provider Demographics
NPI:1184279846
Name:SAGE WINDEMAKER, LCSW, LLC
Entity type:Organization
Organization Name:SAGE WINDEMAKER, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINICAL DIRECTOR, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SAGE
Authorized Official - Middle Name:
Authorized Official - Last Name:WINDEMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:717-364-0385
Mailing Address - Street 1:4 WALNUT DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN UNIVERSITY
Mailing Address - State:PA
Mailing Address - Zip Code:19352-8920
Mailing Address - Country:US
Mailing Address - Phone:717-364-0385
Mailing Address - Fax:
Practice Address - Street 1:330 KENNETT PIKE STE 205B
Practice Address - Street 2:
Practice Address - City:CHADDS FORD
Practice Address - State:PA
Practice Address - Zip Code:19317-8217
Practice Address - Country:US
Practice Address - Phone:717-364-0385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty