Provider Demographics
NPI:1245755289
Name:BEDFORD-JACK, EMMA (LCSW, LICSW)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:BEDFORD-JACK
Suffix:
Gender:F
Credentials:LCSW, LICSW
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:
Other - Last Name:BEDFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:211 N WHITFIELD ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3039
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:211 N WHITFIELD ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3039
Practice Address - Country:US
Practice Address - Phone:412-283-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALICSW1275591041C0700X
PACW0210931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALICSW127559OtherLICENSED INDEPENDENT CLINICAL SOCIAL WORKER
PACW021093OtherLICENSED CLINICAL SOCIAL WORKER